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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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          Abstract

          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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              Progression of Glomerular Sclerosis in Experimental Uremic Rats by Administration of Indole, a Precursor of Indoxyl Sulfate

              In uremia there is a marked elevation of serum levels of indoxyl sulfate due to its decreased renal clearance. Indoxyl sulfate is synthesized in the liver from indole which is produced by bacteria in the intestines. To determine the role of indoxyl sulfate in the progression of chronic renal failure, we administered indole, the precursor of indoxyl sulfate, to subtotally nephrectomized uremic rats. The oral administration of indole increased the serum levels of creatinine and blood urea nitrogen and decreased creatinine, inulin, and p -aminohippuric acid clearances. The glomerular sclerosis index in the indole-treated rats was higher than in the control uremic rats. After oral administration, indole could not be detected in the urine, but large amounts of its metabolite, indoxyl sulfate. Thus, indole administration stimulated glomerular sclerosis in a uremic model through the production of indoxyl sulfate.
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                Author and article information

                Journal
                NEC
                Nephron Clin Pract
                10.1159/issn.1660-2110
                Nephron Clinical Practice
                S. Karger AG
                1660-2110
                2007
                February 2007
                15 December 2006
                : 105
                : 3
                : c99-c107
                Affiliations
                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
                Article
                97985 Nephron Clin Pract 2007;105:c99–c107
                10.1159/000097985
                17179734
                a33fba89-d448-4815-ba9e-9fe1bdabab12
                © 2007 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 10 January 2006
                : 11 January 2006
                Page count
                Figures: 8, Tables: 2, References: 33, Pages: 1
                Categories
                Original Paper

                Cardiovascular Medicine,Nephrology
                AST-120,Chronic kidney disease,Low protein diet,Iothalamate clearance,Spherical adsorptive carbon,Glomerular filtration rate

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