American Journal of Kidney Diseases
Volume 54, Issue 3 , Pages 459-467 , September 2009

Effect of a Carbonaceous Oral Adsorbent on the Progression of CKD: A Multicenter, Randomized, Controlled Trial

  • Tadao Akizawa, MD, PhD

      Affiliations

    • Department of Nephrology, Showa University School of Medicine, Tokyo, Japan
    • ,
  • Yasushi Asano, MD, PhD

      Affiliations

    • Department of Internal Medicine, Koga Red Cross Hospital, Koga, Japan
    • ,
  • Satoshi Morita, PhD

      Affiliations

    • Department of Epidemiology and Healthcare Research, Graduate School of Medicine, Kyoto University, Kyoto, Japan
    • ,
  • Takafumi Wakita, MS

      Affiliations

    • Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto and Tokyo, Japan
    • Department of Psychology, Faculty of Sociology, Kansai University, Osaka, Japan
    • ,
  • Yoshihiro Onishi, PhD, MPH

      Affiliations

    • Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto and Tokyo, Japan
    • ,
  • Shunichi Fukuhara, MD, DMSc

      Affiliations

    • Department of Epidemiology and Healthcare Research, Graduate School of Medicine, Kyoto University, Kyoto, Japan
    • Corresponding Author InformationAddress correspondence to Shunichi Fukuhara, MD, DMSc, Department of Epidemiology and Healthcare Research, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoemachi, Sakyo-ku, Kyoto, 606 8501, Japan
    • ,
  • Fumitake Gejyo, MD, PhD

      Affiliations

    • Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
    • ,
  • Seiichi Matsuo, MD, PhD

      Affiliations

    • Nagoya University Graduate School of Medicine, Nagoya, Japan
    • ,
  • Noriaki Yorioka, MD, PhD

      Affiliations

    • Department of Advanced Nephrology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
    • ,
  • Kiyoshi Kurokawa, MD

      Affiliations

    • National Graduate Institute for Policy Studies, Tokyo, Japan
    • ,
  • CAP-KD Study Group

Received 2 September 2008 ,Accepted 13 May 2009.

References 

  1. Nakagawa N, Hasebe N, Sumitomo K, et al. An oral adsorbent, AST-120, suppresses oxidative stress in uremic rats. Am J Nephrol. 2006;26:455–461
  2. Taki K, Niwa T. Indoxyl sulfate-lowering capacity of oral sorbents affects the prognosis of kidney function and oxidative stress in chronic kidney disease. J Ren Nutr. 2007;17:48–52
  3. Shimoishi K, Anraku M, Kitamura K, et al. An oral adsorbent, AST-120 protects against the progression of oxidative stress by reducing the accumulation of indoxyl sulfate in the systemic circulation in renal failure. Pharm Res. 2007;24:1283–1289
  4. Kobayashi N, Maeda A, Horikoshi S, Shirato I, Tomino Y, Ise M. Effects of oral adsorbent AST-120 (Kremezin) on renal function and glomerular injury in early-stage renal failure of subtotal nephrectomized rats. Nephron. 2002;91:480–485
  5. Okada K, Okawa E, Shibahara H, et al. Combination therapy with angiotensin-converting enzyme inhibitor and oral adsorbent of uremic toxins can delay the appearance of glomerular sclerosis and interstitial fibrosis in established renal failure. Kidney Blood Press Res. 2004;27:218–225
  6. Okada K, Matsumoto K, Takahashi S. Uremic toxins adsorbed by AST-120 promote tubular hypertrophy and interstitial fibrosis in nephrectomized rats. Kidney Blood Press Res. 2005;28:8–13
  7. Imai E, Takenaka M, Isaka Y, et al. Carbonic adsorbent AST-120 retards progression of renal failure by additive effect with ACEI and protein restriction diet. Clin Exp Nephrol. 2003;7:113–119
  8. Koide K, Sano M, Takeda F, Momose T, Koshikawa S, Akizawa T. A study of oral adsorbent in chronic renal failure. Biomater Artif Cells Immobilization Biotechnol. 1991;19:147–166
  9. Shoji T, Wada A, Inoue K, et al. Prospective randomized study evaluating the efficacy of the spherical adsorptive carbon AST-120 in chronic kidney disease patients with moderate decrease in renal function. Nephron Clin Pract. 2007;105:c99–c107
  10. Sanaka T, Fujimoto K, Niwayama J, et al. Effect of combined treatment of oral sorbent with protein-restricted diet on change of reciprocal creatinine slope in patients with CRF. Am J Kidney Dis. 2003;41(suppl 1):S35–S37
  11. Takahashi N, Kawaguchi T, Suzuki T. Therapeutic effects of long-term administration of an oral adsorbent in patients with chronic renal failure: Two-year study [erratum in Int J Urol 13:98, 2006]. Int J Urol. 2005;12:7–11
  12. Schulman G, Agarwal R, Acharya M, Berl T, Blumenthal S, Kopyt N. A multicenter, randomized, double-blind, placebo-controlled, dose-ranging study of AST-120 (Kremezin) in patients with moderate to severe CKD. Am J Kidney Dis. 2006;47:565–577
  13. Ueda H, Shibahara N, Takagi S, Inoue T, Katsuoka Y. AST-120, an oral adsorbent, delays the initiation of dialysis in patients with chronic kidney diseases. Ther Apher Dial. 2007;11:189–195
  14. Kang HY, Cho W, Lee S, Kim HJ, Lee HY, Woo TW. [Estimating the cost savings due to the effect of Kremezin in delaying the initiation of dialysis treatments among patients with chronic renal failure] [in Korean]. J Prev Med Public Health. 2006;39:149–158
  15. Yorioka N, Kiribayashi K, Naito T, et al. An oral adsorbent, AST-120, combined with a low-protein diet and RAS blocker, for chronic kidney disease. J Nephrol. 2008;21:213–220
  16. Morita S, Fukuhara S, Akizawa T, Asano Y, Kurokawa K. Study design and methods for a clinical trial of an oral carbonaceous adsorbent used to prevent the progression of chronic kidney disease (CAP-KD). Clin Exp Nephrol. 2005;9:219–227
  17. Horio M, Orita Y, Manabe S, Sakata M, Fukunaga M. Formula and nomogram for predicting creatinine clearance from serum creatinine concentration. Clin Exp Nephrol. 1997;1:110–114
  18. Matsuo S, Imai E, Horio M, et al. Revised equations for estimating glomerular filtration rate (GFR) from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–992
  19. Akizawa T, Koide K, Koshikawa S. Effects of Kremezin on patients with chronic renal failure: Results of a nationwide clinical study (in Japanese). Kidney Dial. 1998;45:373–388
  20. Pocock SJ, Simon R. Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics. 1975;31:103–115

 Originally published online as doi: 10.1053/j.ajkd.2009.05.011 on July 21, 2009.

 A list of the members of the Carbonaceous Oral Adsorbent's Effects on Progression of Chronic Kidney Disease (CAP-KD) Study Group appears at the end of this article.

 Trial registration: www.ClinicalTrials.gov; study number: NCT00456859.

PII: S0272-6386(09)00834-8

doi: 10.1053/j.ajkd.2009.05.011

American Journal of Kidney Diseases
Volume 54, Issue 3 , Pages 459-467 , September 2009

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