대한신장학회

논문분류	춘계학술대회 초록집
제목	The Effect of AST-120 (Kremezin®) on the Progression of Chronic Kidney Disease in Korea
저자	Ran-hui Cha1, Shin Wook Kang2, Dae Ryong Cha3, Jae Hyun Chang4, Sun Ae Yoon5, Chun Soo Lim6, Sang Yeop Han7, Cheol-whee Park8, Ki Young Na9, Sung Gyun Kim10, Jung Hwan Park11, Yon Su Kim12
출판정보	2014; 2014(1):
키워드	만성콩팥병,크레메진,효과
초록	Background: AST-120 is an oral adsorbent excreting uremic toxins including indoxyl sulfate into feces. And AST-120 was effective in reducing the renal function decline and proteinuria as well as in improving the pathologic changes of renal diseases. However, AST-120 did not prove the capability to delay the initiation of renal replacement therapy in chronic kidney disease (CKD) patients. We aimed to find the long-term effect of AST-120 on the renal progression (doubling of SCr, creatinine clearance (CCr) decrease more than 50%, or initiation of renal replacement therapy) in patients with moderate to severe CKD. Methods: We prospectively recruited 579 patients (CKD stage 3 and 4) from 11 medical centers in Korea and randomized them into AST-120 and control arm through the mixed block randomization as well as being stratified according to both the gender and the cause of CKD. A total of 6 gram of AST-120 in 3 divided doses was given to participants in AST-120 arm as well as standard conventional treatment. They were followed up every 3 months up to 36 months. Results: A total of 465 patients were evaluated. Medication compliance of AST-120 was 89.9±11.82% (median 93.9%). Mean SCr and estimated CCr level was 2.81±0.666 mg/dl and 26.79±7.263 ml/min/1.73m2, respectively. There was no significant difference in the occurrence of composite primary outcomes between two treatment arms (Log-rank p=0.330). Diabetic nephropathy and renal dysfunction were risk factors for the occurrence of primary outcomes and both additively affected (Log-rank p<0.001). The velocity of estimated CCr decline was less in AST-120 arm and this was especially profound in patients with diabetic nephropathy. The slope of 1/SCr significantly decreased in both two treatment arms and the value of AST-120 arm was less than that of control arm (p<0.05). Urinary protein excretion rate was decreased from 2.04±1.980 g/g Cr to 1.79±2.023 g/g Cr in control arm and from 1.97±2.053 g/g Cr to 1.234±1.198 g/g Cr in AST-120 arm (p<0.05). Conclusions: AST-120 slowed the renal function decline although it did not affect on the occurrence of primary outcome. Longer period of observation of the participants with or without AST-120 is needed.
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