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. 2019 Oct 17;8(10):1718.
doi: 10.3390/jcm8101718.

Effects and Safety of an Oral Adsorbent on Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis

Ying-Chun Chen  1 , Mei-Yi Wu  2   3   4   5 , Ping-Jen Hu  6   7 , Tzu-Ting Chen  8   9 , Wan-Chen Shen  10 , Wei-Chiao Chang  11   12   13   14 , Mai-Szu Wu  15   16
Affiliations

Effects and Safety of an Oral Adsorbent on Chronic Kidney Disease Progression: A Systematic Review and Meta-Analysis

Ying-Chun Chen et al. J Clin Med. .

Abstract

Background: AST-120 (Kremezin), which is an oral spherical carbon adsorbent, has been reported to have the potential for retarding disease progression in patients with chronic kidney disease. We aimed to evaluate its efficacy and safety in this study.

Methods: We systematically searched for randomized controlled trials published in PubMed, Embase, and Cochrane databases. The primary outcomes were the renal outcome and all-cause mortality, and the change in serum indoxyl sulfate (IS) levels. The safety outcome was also evaluated in terms of reported major adverse events. A random-effects model was used when heterogeneity was expected.

Results: Eight studies providing data for 3349 patients were included in the meta-analysis. The risk ratio of renal outcome and all-cause mortality were 0.97 (95% CI: 0.88-1.07; 6 trials) and 0.94 (0.73-1.20; 5 trials), respectively. Furthermore, the weighted mean change in IS levels from baseline to the end of the study was -0.28 mg/dL (95% CI: -0.46 to -0.11; 4 trials).

Conclusions: This study provides evidence that AST-120 can effectively lower IS levels but still controversial in terms of slowing disease progression and all-cause mortality. Except for dermatological events, the incidence of adverse events did not differ significantly between the AST-120 and placebo groups.

Keywords: AST-120; Kremezin; chronic kidney disease; meta-analysis; systematic review.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the literature search and trial selection.
Figure 2
Figure 2
Risk of bias. (A) Risk of bias summary; (B) Risk of bias graph.
Figure 3
Figure 3
Result of primary outcomes for comparison between AST-120 and control groups. (A) Composite of renal outcome; (B) All-cause mortality; (C) Change in serum indoxyl sulfate levels.
Figure 4
Figure 4
Result of secondary outcomes for comparison between AST-120 and control groups. (A) Constipation; (B) Diarrhea; (C) Gastrointestinal disorders; (D) Dermatological events.
See this image and copyright information in PMC

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