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      Prospective Randomized Study Evaluating the Efficacy of the Spherical Adsorptive Carbon AST-120 in Chronic Kidney Disease Patients with Moderate Decrease in Renal Function

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          Aims: We studied whether adding the spherical adsorptive carbon AST-120 to conventional treatments is effective in inhibiting progression of chronic kidney disease (CKD) at the stage of moderate decrease in renal function. Methods: 43 CKD patients with moderately impaired renal function indicated by glomerular filtration rate (GFR) of 20–70 ml/min as measured by non-radiolabeled iothalamate clearance method were enrolled in the study. 26 patients showing a decrease of GFR by 5 ml/min during a 1-year observation period were randomized to receive ongoing treatments only (control group, 12 cases) or with AST-120 co-administered with ongoing treatment (AST-120 group, 14 cases). The intervention period was 1 year and the change in GFR was the primary evaluation variable. Results: The mean changes of GFR per month (ΔGFR) in the intervention period were not significantly different between both groups. However, when comparing the ΔGFR in the observation and intervention periods for each group, the rate of decline in GFR was significantly retarded (p < 0.001) in the AST-120 group while no significant difference was observed in the control group. Conclusion: These results suggest that co-administration of AST-120 with conventional treatments retards decline in renal function in CKD patients with moderate decrease in renal function.

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          The randomization and stratification of patients to clinical trials.

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            A simple method of estimating progression of chronic renal failure.

            In 31 of 34 patients with chronic renal insufficiency caused by various diseaes, reciprocal serum-creatinine concentration declined linearly as creatinine concentration rose from a mean of 2-6 mg/dl to 14-8 mg/dl over an average of 71 months. These results indicate that in most cases reciprocal serum-creatinine declines linearly with time as chronic renal failure progresses. Analysis of this relation in individual patients gives an estimate of the progression of the disease, may help to determine the effects of therapy, and could be used to predict when dialysis will become necessary.
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              Oral Adsorbent AST-120 Decreases Carotid Intima-Media Thickness and Arterial Stiffness in Patients with Chronic Renal Failure

              Background/Aim: Intima media thickness (IMT) and stiffness of the carotid arteries is related to coronary artery disease, and chronic renal failure patients are at high risk for such diseases. An oral adsorbent, AST-120 (Kremezin; Kureha Chemical Industry, Tokyo, Japan), can delay the progression of chronic renal failure in undialyzed uremic patients. The aim of the present study was to determine whether AST-120 affects carotid artery IMT and pulse wave velocity (PWV) in patients with chronic renal failure not undergoing dialysis. Methods: Fifty patients with non-diabetic chronic renal failure were randomly divided into two groups: 30 patients (18 men and 12 women; mean age 53.5 years; mean serum creatinine 3.2 mg/dl) who were given AST-120 (6.0 g/day) and 20 patients (12 men and 8 women; mean age 52.0 years; mean serum creatinine 3.5 mg/dl) who were not given AST-120. Thirty healthy age-matched subjects (18 men and 12 women; mean age 51.5 years; mean serum creatinine 0.9 mg/dl) were also included. The treatment period was 24 months. IMT and arterial stiffness were measured before and after treatment. Results: The slope of the reciprocal serum creatinine concentration over time became significantly less steep in the AST-120 group than in the non-AST-120 group (p < 0.001). Before treatment, carotid artery IMT differed little between the AST-120 group (0.90 ± 0.22 mm) and the non-AST-120 group (0.88 ± 0.20 mm). IMT in these two groups was significantly greater than IMT in the control group (0.64 ± 0.14 mm) (p < 0.01). Carotid IMT in the AST-120 group decreased slightly but not significantly to 0.84 ± 0.20 mm after 12 months and then significantly after 24 months to 0.78 ± 0.18 mm (p < 0.05). Carotid IMT in the non-AST group showed little change throughout the experimental period. PWV differed little between the AST-120 group (1,980 ± 330 cm/s) and the non-AST group (1,940 ± 360 cm/s) before treatment. PWV values in these two groups were significantly greater than PWV in the control group (1,280 ± 240 cm/s) (p < 0.01). After 12 and 24 months, PWV in the AST-120 group decreased significantly to 1,840 ± 280 cm/s (p < 0.05) and to 1,780 ± 260 cm/s (p < 0.05), respectively; however, PWV in the non-AST group showed a slight increase during the experimental period. Conclusion: The data suggest that AST-120 may reduce arterial stiffness and IMT in non-diabetic chronic renal failure patients before dialysis.

                Author and article information

                Nephron Clin Pract
                Nephron Clinical Practice
                S. Karger AG
                February 2007
                15 December 2006
                : 105
                : 3
                : c99-c107
                aDepartment of Nephrology, Osaka General Medical Center, bDepartment of General Internal Medicine, National Hospital Organization Osaka National Hospital, and cDepartment of Nephrology, Osaka University Graduate School of Medicine, Osaka, Japan
                97985 Nephron Clin Pract 2007;105:c99–c107
                © 2007 S. Karger AG, Basel

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                Figures: 8, Tables: 2, References: 33, Pages: 1
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