Predictive Factors for Efficacy of AST-120 Treatment in Diabetic Nephropathy: a Prospective Single-Arm, Open-Label, Multi-Center Study
10.3346/jkms.2019.34.e117
- Author:
You Cheol HWANG
1
;
Se Won KIM
;
Kyu Yeon HUR
;
Bong Soo CHA
;
In Joo KIM
;
Tae Sun PARK
;
Sei Hyun BAIK
;
Kun Ho YOON
;
Kwan Woo LEE
;
In Kyu LEE
;
Moon Kyu LEE
Author Information
1. Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
- Publication Type:Multicenter Study
- Keywords:
Diabetic Nephropathy;
Indoxyl Sulfate;
Creatinine;
Oxidative Stress;
Antioxidants
- MeSH:
Antioxidants;
Blood Pressure;
Creatinine;
Diabetic Nephropathies;
Dialysis;
Humans;
Indican;
Korea;
Lipid Peroxidation;
Oxidative Stress;
Prospective Studies;
Renal Insufficiency, Chronic
- From:Journal of Korean Medical Science
2019;34(15):e117-
- CountryRepublic of Korea
- Language:English
-
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.
