An oral adsorbent, AST-120, combined with a low-protein diet and RAS blocker, for chronic kidney disease.
BACKGROUND
A low-protein diet and treatment with renin-angiotensin system (RAS) blockers can delay the progression of chronic kidney disease (CKD). The oral adsorbent AST-120 (Kremezin) has a renoprotective effect by reducing serum levels of uremic toxins. We investigated the influence of AST-120 on the preservation of renal function in patients with CKD.


METHODS
Twenty-eight patients were randomized to 2 groups: 15 patients receiving 6.0 g of AST-120 daily for 12 months plus a low-protein diet and RAS blocker therapy (group A) and 13 patients who were not given AST-120 (group B). All of them had shown progressive deterioration of renal function with basal treatment. Mean baseline serum creatinine level (+/- standard deviation) was 2.4 +/- 0.8 mg/dL in group A and 2.7 +/- 0.8 mg/dL in group B. There were no significant differences in background parameters before AST-120 therapy.


RESULTS
The change in the estimated glomerular filtration rate (eGFR) was significantly smaller in group A than in group B. The change was also significantly smaller in patients with a baseline serum creatinine <2.4 mg/dL and in patients with rapid progression. After 12 months, the slope of the eGFR curve was significantly less steep compared with baseline in group A (-1.77 vs. -0.52 ml/min per month), but there was no significant change in group B. The slope was also significantly less steep in patients with rapid progression.


CONCLUSIONS
Adding AST-120 to a low-protein diet and RAS blocker therapy may delay the deterioration of chronic renal failure, especially in patients with early or rapid progression.
Yorioka
Noriaki
N
Department of Advanced Nephrology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan. nyorioka@hiroshima-u.ac.jp
Kiribayashi
Kei
K
Naito
Takayuki
T
Ogata
Satoshi
S
Yokoyama
Yukio
Y
Kyuden
Yasufumi
Y
Ogawa
Takahiko
T
Wada
Koji
K
Hayashi
Kanoko
K
Hirabayashi
Akira
A
D000327:Adsorption; D000328:Adult; D000368:Aged; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001806:Blood Urea Nitrogen; D002244:Carbon / Q000627:therapeutic use*; D003404:Creatinine; D018753:Diet, Protein-Restricted; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010087:Oxides / Q000627:therapeutic use*
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010087:Oxides; D002244:Carbon; C040896:AST 120; D003404:Creatinine