AST-120 for the management of progression of chronic kidney disease
https://doi.org/10.24884/1561-6274-2015-19-1-156-167
Abstract
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.
About the Authors
Gerald Schulman
Vanderbilt University School of Medicine
United States
United States
R. . Vanholder
University Hospital
Belgium
Belgium
T. . Niwa
Japan
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Review
For citations:
Schulman G., Vanholder R., Niwa T. AST-120 for the management of progression of chronic kidney disease. Nephrology (Saint-Petersburg). 2015;19(1):21-29. (In Russ.) https://doi.org/10.24884/1561-6274-2015-19-1-156-167
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