nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.24884/1561-6274-2015-19-1-156-167nefr-69Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESAST-120: контроль над прогрессированием хронической болезни почекAST-120 for the management of progression of chronic kidney diseaseШулманД. .SchulmanGeraldgerald.schulman@vanderbilt.eduВанхолдерР. .VanholderR. .noemail@neicon.ruНиваТ. .NiwaT. .noemail@neicon.ruУниверситет ВандербилтаСоединённые Штаты АмерикиVanderbilt University School of MedicineUnited StatesУниверситетская больницаБельгияUniversity HospitalBelgium2015010120151912129Copyright © Шулман Д..., Ванхолдер Р..., Нива Т..., 20152015Шулман Д..., Ванхолдер Р..., Нива Т...Schulman G., Vanholder R..., Niwa T...Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/69

Уремические токсины, такие как индоксил сульфат, вносят вклад в патогенез хронической болезни почек (ХБП), способствуя развитию гломерулосклероза и интерстициального фиброза с утратой нефронов и повреждением сосудов. AST-120, принимаемый перорально интестинальный сорбент, адсорбирует индол - вещество-предшественник индоксил сульфата, таким образом уменьшая концентрацию индоксил сульфата в сыворотке крови и моче. С 1991 года AST-120 стал доступен в Японии, позднее - в Корее (с 2005 года) и в Республике Филиппины (с 2010 года) в качестве препарата, продлевающего время до начала гемодиализа и облегчающего симптомы уремии у пациентов с ХБП. Для выявления информации о клиническом опыте использования AST-120 для лечения ХБП был произведен поиск по базе данных Medline. Были отобраны проспективные открытые исследования без применения плацебо-контроля, проспективные двойные слепые исследования, а также ретроспективные анализы. И в проспективных исследованиях, и в ретроспективных анализах было показано, что AST-120 продлевает время до начала гемодиализа и замедляет снижение СКФ и повышение уровня сывороточного креатинина. В первом рандомизированном двойном слепом плацебо-контролируемом исследовании, проводимом в США, была показана достоверная связь приема AST-120 с дозозависимым снижением концентрации индоксил сульфата в сыворотке крови и со снижением ассоциированного с уремией дискомфорта. В Северной и Латинской Америке и Европе предприняты два двойные слепые плацебо-контролируемые исследования для оценки предупреждения прогрессирования ХБП (The Evaluating Prevention of Progression in CKD (EPPIC)), оценивающие эффективность AST-120 для предупреждения прогрессирования ХБП. Результаты этих исследований помогут далее определить роль AST-120 при этом тяжелом состоянии.

Uremic toxins such as indoxyl sulfate contribute to the pathogenesis of chronic kidney disease (CKD) by promoting glomerulosclerosis and interstitial fibrosis with loss of nephrons and vascular damage. AST-120, an orally administered intestinal sorbent, adsorbs indole, a precursor of indoxyl sulfate, thereby reducing serum and urinary concentrations of indoxyl sul-fate. AST-120 has been available in Japan since 1991, and subsequently Korea (2005), and the Philippines (2010) as an agent to prolong the time to initiation of hemodialysis and for improve-ment of uremic symptoms in patients with CKD. A Medline search was performed to identify data supporting clinical experience with AST-120 for managing CKD. Prospective open-label and double-blind trials as well as retrospective analyses were included. In prospective trials and retrospective analyses, AST-120 has been shown to prolong the time to initiation of hemodialy-sis, and slow decline in glomerular filtration rate and the increase serum creatinine. In an initial randomized, double-blind, placebo-controlled trial in the United States, AST-120 was associated with a significant dose-dependent reduction in serum indoxyl sulfate levels and a decrease in uremia-related malaise. The Evaluating Prevention of Progression in CKD (EPPIC) trials, two double-blind, placebo-controlled trials undertaken in North America/Latin America and Europe, are evaluating the efficacy of AST-120 for preventing the progression of CKD. The results of the EPPIC trials will further define the role of AST-120 in this debilitating condition.

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The authors declare that there are no conflicts of interest present.