Abstract
Background: AST-120 (Kremezin), which is an oral spherical carbon adsorbent, has been reported to have the potential for retarding disease progression in patients with chronic kidney disease. We aimed to evaluate its efficacy and safety in this study. Methods: We systematically searched for randomized controlled trials published in PubMed, Embase, and Cochrane databases. The primary outcomes were the renal outcome and all-cause mortality, and the change in serum indoxyl sulfate (IS) levels. The safety outcome was also evaluated in terms of reported major adverse events. A random-effects model was used when heterogeneity was expected. Results: Eight studies providing data for 3349 patients were included in the meta-analysis. The risk ratio of renal outcome and all-cause mortality were 0.97 (95% CI: 0.88–1.07; 6 trials) and 0.94 (0.73–1.20; 5 trials), respectively. Furthermore, the weighted mean change in IS levels from baseline to the end of the study was −0.28 mg/dL (95% CI: −0.46 to −0.11; 4 trials). Conclusions: This study provides evidence that AST-120 can effectively lower IS levels but still controversial in terms of slowing disease progression and all-cause mortality. Except for dermatological events, the incidence of adverse events did not differ significantly between the AST-120 and placebo groups.
Highlights
Chronic kidney disease (CKD) is a global health concern [1] where many patients with the disease advance to end-stage renal disease (ESRD), which requires dialysis or kidney transplantation, increases mortality, and reduces quality of life [1,2]
Of these 65, we excluded studies that were not randomized controlled trial (RCT), studies that did not have a control group, and those in which the population, intervention, and outcomes did not meet the requirements of our meta-analysis
Using a fixed-effect model, we found that the risk ratios (RRs) of the composite of renal outcomes was 0.97
Summary
Chronic kidney disease (CKD) is a global health concern [1] where many patients with the disease advance to end-stage renal disease (ESRD), which requires dialysis or kidney transplantation, increases mortality, and reduces quality of life [1,2]. AST-120 is an orally administered adsorbent, which consists of spherical particles 0.2–0.4 mm in diameter It is predominantly composed of carbon [6] and can adsorb uremic toxins and precursors, such as indoxyl sulfate (IS), causing their subsequent excretion in feces [6,7]. AST-120 was first approved in Japan in 1991 to alleviate uremic symptoms and delay the need for dialysis in patients with CKD [6]. AST-120 (Kremezin), which is an oral spherical carbon adsorbent, has been reported to have the potential for retarding disease progression in patients with chronic kidney disease. Conclusions: This study provides evidence that AST-120 can effectively lower IS levels but still controversial in terms of slowing disease progression and all-cause mortality. Except for dermatological events, the incidence of adverse events did not differ significantly between the AST-120 and placebo groups
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