title: AST-120 Improves Microvascular Endothelial Dysfunction in End-Stage Renal Disease Patients Receiving Hemodialysis.
abstract: OBJECTIVE
  Endothelial dysfunction (ED) is a pivotal phenomenon in the development of cardiovascular disease (CVD) in patients receiving hemodialysis (HD). Indoxyl sulfate (IS) is a known uremic toxin that induces ED in patients with chronic kidney disease. The aim of this study was to investigate whether AST-120, an absorbent of IS, improves microvascular or macrovascular ED in HD patients.
  
  
  METHODS
  We conducted a prospective, case-controlled trial. Fourteen patients each were enrolled in respective AST-120 and control groups. The subjects in the AST-120 group were treated with AST-120 (6 g/day) for 6 months. Microvascular function was assessed by laser Doppler flowmetry using iontophoresis of acetylcholine (Ach) and sodium nitroprusside (SNP) at baseline and again at 3 and 6 months. Carotid arterial intima-media thickness (cIMT) and flow-mediated vasodilation were measured at baseline and 6 months. The Wilcoxon rank test was used to compare values before and after AST-120 treatment.
  
  
  RESULTS
  Ach-induced iontophoresis (endothelium-dependent response) was dramatically ameliorated at 3 months and 6 months in the AST-120 group. SNP-induced response showed delayed improvement only at 6 months in the AST-120 group. The IS level was decreased at 3 months in the AST-120 group, but remained stable thereafter. cIMT was significantly reduced after AST-120 treatment. No significant complications in patients taking AST-120 were reported.
  
  
  CONCLUSIONS
  AST-120 ameliorated microvascular ED and cIMT in HD patients. A randomized study including a larger population will be required to establish a definitive role of AST-120 as a preventive medication for CVD in HD patients.
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Jung Hwa
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Mina
authors.initials: M
authors.lastname: Yu
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Sihna
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Dong Ryeol
authors.initials: DR
authors.lastname: Ryu
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Duk Hee
authors.initials: DH
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. kbchoi@ewha.ac.kr.
authors.forename: Kyu Bok
authors.initials: KB
authors.lastname: Choi
mesh_terms: D000109:Acetylcholine; D000328:Adult; D002244:Carbon / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D059168:Carotid Intima-Media Thickness; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007478:Iontophoresis; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation / Q000502:physiology; D008875:Middle Aged; D009599:Nitroprusside; D010087:Oxides / Q000627:therapeutic use*; D011446:Prospective Studies; D006435:Renal Dialysis; D055815:Young Adult
chemical_list: D010087:Oxides; D009599:Nitroprusside; D002244:Carbon; C040896:AST 120; D000109:Acetylcholine
keywords: AST-120; endothelial dysfunction; hemodialysis; indoxyl sulfate; laser-Doppler flowmetry; microvascular circulation