Effect of AST-120 in Chronic Kidney Disease Treatment: Still a Controversy?
Abstract
AST-120 (kremezin; Kureha Chemical, Tokyo, Japan) is an oral spherical carbonaceous adsorbent, which was approved for clinical use in Japanese chronic kidney disease (CKD) patients in 1991. It adsorbs indole, the precursor of indoxyl sulfate, in the intestines and prevents indoxyl sulfate production. Indoxyl sulfate, initially identified as a major uremic toxin that causes uremic symptoms, contributes to CKD progression. Since AST-120 decreases serum indoxyl sulfate in a dose-dependent manner, multicenter prospective trials have been conducted in Japan in the 1980s; these trials were mostly in favor of the efficacy of AST-120 in delaying the initiation of dialysis in patients with advanced stage CKD. Many animal studies support the effects of AST-120 on renal outcomes as well as on cardiovascular complications. However, there are yet no reports that unequivocally demonstrate the improvement of hard renal endpoints and/or cardiovascular endpoints. This commentary briefly reviews the major outcomes of the recent clinical trials on AST-120.
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The spherical carbon adsorbent AST-120 absorbs indole produced in the intestine and thereby reduces serum and urinary levels of indoxyl sulfate.
“The spherical carbon adsorbent AST-120 absorbs indole produced in the intestine and thereby reduces serum and urinary levels of indoxyl sulfate228.”
From The gut microbiota and the brain–gut–kidney axis in hypertension and chronic kidney disease (2018) · cites this paper as [228]
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- Authors
- Yamaguchi, J., Tanaka, T., & Inagi, R.
- Affiliations
- The University of Tokyo (JP)
- Venue
- Nephron
- Publisher
- S. Karger AG
- Published
- 2016-12-14
- Volume
- 135
- Issue
- 3
- Pages
- 201-206
- ISSN
- 1660-8151 (ISSN-L)
- 2235-3186
- OpenAlex
- W2562681941
- Cited by
- 60
- References
- 19
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 7 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 8 · 2017: 5
- FWCI
- 7.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Nephron journals/Nephron journals (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- AST-120, chronic kidney disease, indoxyl sulfate, uremic toxins, dialysis initiation, cardiovascular outcomes, renal outcomes, clinical trial results
- MeSH terms
- Adsorption, Animals, Carbon, Clinical Trials as Topic, Humans, Indican, Japan, Oxides, Toxins, Biological, Renal Insufficiency, Chronic
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