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Abstract: TH-PO447

AST-120 Can Delay the Decline of Renal Function in Patients with CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Suzuki, Hitoshi, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Fukao, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Nakayama, Maiko, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Kato, Rina, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Nihei, Yoshihito, Juntendo University Faculty of Medicine, Tokyo, Japan
  • Suzuki, Yusuke, Juntendo University Faculty of Medicine, Tokyo, Japan
Background

AST-120 (KREMEZIN®, Kureha Chemical, Tokyo, Japan) consists of oral spherical carbonaceous adsorbent, which was approved for use in delaying the initiation of dialysis and ameliorating the symptoms of uremia in patients with progressive chronic kidney disease (CKD). It adsorbs the precursor of indoxyl sulfate in the intestines and prevents indoxyl sulfate production. Indoxyl sulfate, initially identified as a major uremic toxin that causes uremic symptoms, contributes to CKD progression. Although international multicenter prospective trials of AST-120 did not slow progression of CKD in patients with moderate to severe CKD, present study evaluated the efficacy of AST-120 in preventing the progression of CKD and its indication in our Japanese cohort.

Methods

Antihypertensive therapy using renin-angiotensin-aldosterone inhibitor (RAS-i) and a low-protein diet is conventionally used to treat patients with CKD. We retrospectively recruited 225 patients with CKD treated with AST-120 from 2014 to 2016. Changes of serum levels of blood urea nitrogen (BUN) and eGFR were analyzed for 4 years, from 1 year before medication. Moreover, we elucidated the recommended timing of initiation of AST-120 administration.

Results

The mean eGFR and BUN at the baseline were 25.7 ml/min/1.73m2 and 33.1 mg/dL, respectively. Decline of eGFR before AST-120 treatment was -5.4 ml/min/1.73m2/year. After 1-year and 3-year medication with AST-120, the decline of eGFR was significantly improved to -1.1 and -2.3 ml/min/1.73m2/year, respectively. AST-120 treatment was effective to decline the eGFR slope even in patients with diabetes mellitus as well as patients with high amount of proteinuria (over 1.0g/gCr). We next divided patients into 3 groups depending on baseline eGFR, i.e., >50 eGFR ≥40, >40 eGFR ≥30 and eGFR<30 ml/min/1.73m2 groups. The effect of AST-120 to prevent progression of CKD was the highest in >50 eGFR ≥40 group in which decline of eGFR was -7.8 to -2.0 ml/min/1.73m2/year during intervention period.

Conclusion

Present study suggests that treatment with AST-120 may delay the decline of renal function in patients with CKD. Especially, AST-120 administration is recommended to initiate relatively maintained renal function (>50 eGFR ≥40). AST120 is useful for management of CKD patients.

Funding

  • Government Support - Non-U.S.