J Korean Med Sci.  2019 Apr;34(15):e117. 10.3346/jkms.2019.34.e117.

Predictive Factors for Efficacy of AST-120 Treatment in Diabetic Nephropathy: a Prospective Single-Arm, Open-Label, Multi-Center Study

Affiliations
  • 1Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
  • 2Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. leemk@skku.edu
  • 3Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
  • 5Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea.
  • 6Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  • 7Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 8Department of Internal Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
  • 9Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.

Abstract

BACKGROUND
Removal of uremic toxins such as indoxyl sulfate by AST-120 is known to improve renal function and delay the initiation of dialysis in patients with advanced chronic kidney disease. However, it is unclear whether the addition of AST-120 to conventional treatments is effective in delaying the progression of renal dysfunction in patients with diabetic nephropathy.
METHODS
A total of 100 patients with type 2 diabetes and renal dysfunction (serum creatinine levels ranging from 1.5 to 3.0 mg/dL) were recruited from eight centers in Korea and treated with AST-120 (6 g/day) for 24 weeks. The primary endpoint was improvement in renal function measured as the gradient of the reciprocal serum creatinine level (1/sCr) over time (i.e., the ratio of 1/sCr time slope for post- to pre-AST-120 therapy). A response was defined as a ratio change of the regression coefficient of 1/sCr ≤ 0.90.
RESULTS
Renal function improved in 80.3% of patients (61/76) after 24 weeks of AST-120 treatment. There were no differences between responder and non-responder groups in baseline characteristics except for diastolic blood pressure (73.5 ± 9.5 mmHg in the responder group vs. 79.3 ± 11.1 mmHg in the non-responder group; P = 0.046). Serum lipid peroxidation level decreased significantly in the responder group (from 2.25 ± 0.56 μmol/L to 1.91 ± 0.72 μmol/L; P = 0.002) but not in the non-responder group.
CONCLUSION
The addition of AST-120 to conventional treatments may delay the progression of renal dysfunction in diabetic nephropathy. The antioxidant effect of AST-120 might contribute to improvement in renal function.

Keyword

Diabetic Nephropathy; Indoxyl Sulfate; Creatinine; Oxidative Stress; Antioxidants

MeSH Terms

Antioxidants
Blood Pressure
Creatinine
Diabetic Nephropathies*
Dialysis
Humans
Indican
Korea
Lipid Peroxidation
Oxidative Stress
Prospective Studies*
Renal Insufficiency, Chronic
Antioxidants
Creatinine
Indican
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