Effect of An Oral Absorbent AST-120 in Late-stage Chronic Kidney Disease (CKD) Patients.
Status:
Completed
Trial end date:
2011-12-01
Target enrollment:
Participant gender:
Summary
Recent research work has directed especial attention toward a distinct group of uremic
retension molecules, called "protein-bound uremic toxins". The prototypes of this group of
uremic toxins are indoxyl sulfate and p-cresol. These uremic toxins can promote production of
free radical and impair antioxidant system and exerts direct toxicity on different cells and
organs, including mesangial, tubular, endothelial cell and osteoblasts. Accumulation of these
protein bound uremic toxins results in glomerular sclerosis and interstitial fibrosis of
kidneys of uremic rats and confer skeletal resistance to parthyroid hormone in uremic
patients. In hemodialysis, high serum p-cresol level is associated with higher cardiovascular
mortality.
AST-120 (Kremezin) is a carbonated oral absorbent extensively used in Japan and Korea. It has
superior adsorption ability for certain small-molecular weight organic compounds known to
accumulate in patients with CKD. In uremic rats and CKD patients, oral administration of
AST-120 decreased the elevated pretreatment levels of serum indoxyl sulfate. In Japan, it was
reported that AST-120 suppressed the increase in serum creatinine levels, prevented
proteinuria, improved uremic symptoms, and, consequently, led to the postponement of dialysis
therapy.
Value of AST-120 on the outcome of late-stage CKD patients is still unknown. We hypothesized
AST-120 through reduction of level of indoxyl sulfate and p-cresol can improved the
morbidity- mortality of CKD patients.
The principal aim of this prospective cohort study is to investigate the effectiveness of
AST-120 in incidence of dialysis and mortality of late-stage CKD patients. Determination of
this relationship can help to establish new therapeutic strategy in the treatment of
late-stage CKD patients.