一种口服吸附剂AST-120，联合低蛋白饮食和肾素-血管紧张素系统（RAS）阻滞剂，用于慢性肾脏病。

An oral adsorbent, AST-120, combined with a low-protein diet and RAS blocker, for chronic kidney disease.

作者信息

Yorioka Noriaki, Kiribayashi Kei, Naito Takayuki, Ogata Satoshi, Yokoyama Yukio, Kyuden Yasufumi, Ogawa Takahiko, Wada Koji, Hayashi Kanoko, Hirabayashi Akira

机构信息

Department of Advanced Nephrology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.

出版信息

J Nephrol. 2008 Mar-Apr;21(2):213-20.

PMID:18446716

Abstract

BACKGROUND

A low-protein diet and treatment with renin-angiotensin system (RAS) blockers can delay the progression of chronic kidney disease (CKD). The oral adsorbent AST-120 (Kremezin) has a renoprotective effect by reducing serum levels of uremic toxins. We investigated the influence of AST-120 on the preservation of renal function in patients with CKD.

METHODS

Twenty-eight patients were randomized to 2 groups: 15 patients receiving 6.0 g of AST-120 daily for 12 months plus a low-protein diet and RAS blocker therapy (group A) and 13 patients who were not given AST-120 (group B). All of them had shown progressive deterioration of renal function with basal treatment. Mean baseline serum creatinine level (+/- standard deviation) was 2.4 +/- 0.8 mg/dL in group A and 2.7 +/- 0.8 mg/dL in group B. There were no significant differences in background parameters before AST-120 therapy.

RESULTS

The change in the estimated glomerular filtration rate (eGFR) was significantly smaller in group A than in group B. The change was also significantly smaller in patients with a baseline serum creatinine <2.4 mg/dL and in patients with rapid progression. After 12 months, the slope of the eGFR curve was significantly less steep compared with baseline in group A (-1.77 vs. -0.52 ml/min per month), but there was no significant change in group B. The slope was also significantly less steep in patients with rapid progression.

CONCLUSIONS

Adding AST-120 to a low-protein diet and RAS blocker therapy may delay the deterioration of chronic renal failure, especially in patients with early or rapid progression.

摘要

背景

低蛋白饮食及使用肾素 - 血管紧张素系统（RAS）阻滞剂进行治疗可延缓慢性肾脏病（CKD）的进展。口服吸附剂AST - 120（可利美净）通过降低血清尿毒症毒素水平发挥肾脏保护作用。我们研究了AST - 120对CKD患者肾功能保护的影响。

方法

28例患者随机分为两组：15例患者每日服用6.0 g AST - 120，持续12个月，同时接受低蛋白饮食及RAS阻滞剂治疗（A组）；13例患者未服用AST - 120（B组）。所有患者在基础治疗时均已出现肾功能进行性恶化。A组平均基线血清肌酐水平（±标准差）为2.4±0.8 mg/dL，B组为2.7±0.8 mg/dL。在AST - 120治疗前，两组患者的基线参数无显著差异。

结果

A组估算肾小球滤过率（eGFR）的变化显著小于B组。基线血清肌酐<2.4 mg/dL的患者以及肾功能快速进展的患者中，eGFR的变化同样显著较小。12个月后，A组eGFR曲线的斜率与基线相比显著变缓（-1.77 vs. -0.52 ml/min每月），而B组无显著变化。肾功能快速进展的患者中，斜率也显著变缓。