AST-120 Improves Microvascular Endothelial Dysfunction in End-Stage Renal Disease Patients Receiving Hemodialysis.
10.3349/ymj.2016.57.4.942
- Author:
Jung Hwa RYU
1
;
Mina YU
;
Sihna LEE
;
Dong Ryeol RYU
;
Seung Jung KIM
;
Duk Hee KANG
;
Kyu Bok CHOI
Author Information
1. Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea. kbchoi@ewha.ac.kr
- Publication Type:Controlled Clinical Trial ; Original Article
- Keywords:
AST-120;
hemodialysis;
microvascular circulation;
endothelial dysfunction;
laser-Doppler flowmetry;
indoxyl sulfate
- MeSH:
Acetylcholine;
Adult;
Carbon/*therapeutic use;
Cardiovascular Diseases/etiology/*prevention & control;
Carotid Intima-Media Thickness;
Endothelium, Vascular/*physiopathology;
Female;
Humans;
Iontophoresis;
Kidney Failure, Chronic/complications/*physiopathology/*therapy;
Laser-Doppler Flowmetry;
Male;
Microcirculation/physiology;
Middle Aged;
Nitroprusside;
Oxides/*therapeutic use;
Prospective Studies;
*Renal Dialysis;
Young Adult
- From:Yonsei Medical Journal
2016;57(4):942-949
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Endothelial dysfunction (ED) is a pivotal phenomenon in the development of cardiovascular disease (CVD) in patients receiving hemodialysis (HD). Indoxyl sulfate (IS) is a known uremic toxin that induces ED in patients with chronic kidney disease. The aim of this study was to investigate whether AST-120, an absorbent of IS, improves microvascular or macrovascular ED in HD patients. MATERIALS AND METHODS: We conducted a prospective, case-controlled trial. Fourteen patients each were enrolled in respective AST-120 and control groups. The subjects in the AST-120 group were treated with AST-120 (6 g/day) for 6 months. Microvascular function was assessed by laser Doppler flowmetry using iontophoresis of acetylcholine (Ach) and sodium nitroprusside (SNP) at baseline and again at 3 and 6 months. Carotid arterial intima-media thickness (cIMT) and flow-mediated vasodilation were measured at baseline and 6 months. The Wilcoxon rank test was used to compare values before and after AST-120 treatment. RESULTS: Ach-induced iontophoresis (endothelium-dependent response) was dramatically ameliorated at 3 months and 6 months in the AST-120 group. SNP-induced response showed delayed improvement only at 6 months in the AST-120 group. The IS level was decreased at 3 months in the AST-120 group, but remained stable thereafter. cIMT was significantly reduced after AST-120 treatment. No significant complications in patients taking AST-120 were reported. CONCLUSION: AST-120 ameliorated microvascular ED and cIMT in HD patients. A randomized study including a larger population will be required to establish a definitive role of AST-120 as a preventive medication for CVD in HD patients.
