Dataset Information

Sustained uremic toxin control improves renal and cardiovascular outcomes in patients with advanced renal dysfunction: post-hoc analysis of the Kremezin Study against renal disease progression in Korea.

ABSTRACT:

Background

We investigated the long-term effect of AST-120, which has been proposed as a therapeutic option against renal disease progression, in patients with advanced chronic kidney disease (CKD).

Methods

We performed post-hoc analysis with a per-protocol group of the K-STAR study (Kremezin study against renal disease progression in Korea) that randomized participants into an AST-120 and a control arm. Patients in the AST-120 arm were given 6 g of AST-120 in three divided doses, and those in both arms received standard conventional treatment.

Results

The two arms did not differ significantly in the occurrence of composite primary outcomes (log-rank P = 0.41). For AST-120 patients with higher compliance, there were fewer composite primary outcomes: intermediate tertile hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.38 to 1.01, P = 0.05; highest tertile HR 0.436, 95% CI 0.25 to 0.76, P = 0.003. The estimated glomerular filtration rate level was more stable in the AST-120 arm, especially in diabetic patients. At one year, the AST-120-induced decrease in the serum indoxyl sulfate concentration inversely correlated with the occurrence of composite primary outcomes: second tertile HR 1.59, 95% CI 0.82 to 3.07, P = 0.17; third tertile HR 2.11, 95% CI 1.07 to 4.17, P = 0.031. Furthermore, AST-120 showed a protective effect against the major cardiovascular adverse events (HR 0.51, 95% CI 0.26 to 0.99, P = 0.046).

Conclusion

Long-term use of AST-120 has potential for renal protection, especially in diabetic patients, as well as cardiovascular benefits. Reduction of the serum indoxyl sulfate level may be used to identify patients who would benefit from AST-120 administration.

SUBMITTER: Cha RH

PROVIDER: S-EPMC5331977 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Sustained uremic toxin control improves renal and cardiovascular outcomes in patients with advanced renal dysfunction: <i>post-hoc</i> analysis of the Kremezin Study against renal disease progression in Korea.

Cha Ran-Hui RH Kang Shin Wook SW Park Cheol Whee CW Cha Dae Ryong DR Na Ki Young KY Kim Sung Gyun SG Yoon Sun Ae SA Kim Sejoong S Han Sang Youb SY Park Jung Hwan JH Chang Jae Hyun JH Lim Chun Soo CS Kim Yon Su YS

Kidney research and clinical practice 20170331 1

<h4>Background</h4>We investigated the long-term effect of AST-120, which has been proposed as a therapeutic option against renal disease progression, in patients with advanced chronic kidney disease (CKD).<h4>Methods</h4>We performed <i>post-hoc</i> analysis with a per-protocol group of the K-STAR study (Kremezin study against renal disease progression in Korea) that randomized participants into an AST-120 and a control arm. Patients in the AST-120 arm were given 6 g of AST-120 in three divided ...[more]

PMID: 28392999

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