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

Authors:
You Cheol Hwang
You Cheol Hwang
Kyung Hee University Hospital at Gangdong
Se Won Kim
Se Won Kim
Yeungnam University College of Medicine
Kyu Yeon Hur
Kyu Yeon Hur
Sungkyunkwan University School of Medicine
Bong Soo Cha
Bong Soo Cha
Yonsei University College of Medicine
South Korea
In Joo Kim
In Joo Kim
Pusan National University Hospital
South Korea
Tae Sun Park
Tae Sun Park
Chonbuk National University Medical School
South Korea
Sei Hyun Baik
Sei Hyun Baik
Korea University College of Medicine
Kun Ho Yoon
Kun Ho Yoon
The Catholic University of Korea
South Korea

J Korean Med Sci 2019 Apr 22;34(15):e117. Epub 2019 Apr 22.

Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

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; = 0.046). Serum lipid peroxidation level decreased significantly in the responder group (from 2.25 ± 0.56 μol/L to 1.91 ± 0.72 μol/L; = 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.

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Source
https://jkms.org/DOIx.php?id=10.3346/jkms.2019.34.e117
Publisher Site
http://dx.doi.org/10.3346/jkms.2019.34.e117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473095PMC
April 2019
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