Niwa T, Sugiyama S, Nomura T, Miyazaki T, Tsutsui S, Maeda K
Oral sorbent suppressed progression of renal failure and
production of indoxyl sulfate in undialyzed uremic patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1323 1996
From the time of Hippocrates, the concept of an orally administered
nitrogen-binding sorbent for management of renal disease has been
pursued. Over the past four years, a processed charcoal-derived
sorbent, AST-120, has been in clinical trial in Japan. Prior reports
indicate that a delay in the onset of maintenance hemodialysis is
effected by daily sorbent treatment.
In the present extension of this work, 25 undialyzed uremic patients
given AST-120 (6g/day) were compared with 14 control patients in terms
of the slope of reciprocal serum creatinine against time as well as
serum and urine levels of indoxyl sulfate. A significant slowing of
in rise in creatinine (p <0.05), and reduction of plasma and urine
levels of indoxyl sulfate was observed. The authors infer that
sorbent treatment, by suppressing indoxyl sulfate production by
adsorbing its precursor, indole, retards advancing renal disease.
Comment: Lacking full controls, cautious interpretation is
advised. Other explanations for the findings are possible. For
example, the sorbent may have induced anorexia with wasting of muscle
mass reflected in lower creatinine levels. Nevertheless, every fresh
effort to modify our stultified hemodialysis and peritoneal dialysis
regimens must be applauded. Although more than half-a-million people
worldwide now live because of dialysis, this cumbersome, expensive,
time consuming means of treating ESRD is unavailable to the majority
of the world. The appeal of a simple, inexpensive, oral regimen is
obvious.
(Eli A. Friedman, M.D., SUNY, Health Science Center at
Brooklyn)
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Am Soc Nephrol
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