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. 2024 Feb 21;16(5):4236-4249.
doi: 10.18632/aging.205580. Epub 2024 Feb 21.

AST-120 improved uremic pruritus by lowering indoxyl sulfate and inflammatory cytokines in hemodialysis patients

Chia-Chao Wu  1   2 , Ya-Chung Tian  3 , Chien-Lin Lu  4   5 , Ming-Ju Wu  6   7 , Paik-Seong Lim  8 , Yi-Wen Chiu  9   10 , Ko-Lin Kuo  11   12   13 , Shou-Hsuan Liu  14 , Yu-Ching Chou  15 , Chien-An Sun  16   17 , Yi-Chou Hou  4   18 , Kuo-Cheng Lu  11   19
Affiliations

AST-120 improved uremic pruritus by lowering indoxyl sulfate and inflammatory cytokines in hemodialysis patients

Chia-Chao Wu et al. Aging (Albany NY). .

Abstract

Background and hypothesis: Pruritus is a common and distressing symptom that affects patients with chronic kidney disease. The concentration of protein bounded uremic toxin was associated with the uremic pruritus. The aim is to assess the efficacy of AST-120 for uremic pruritus in hemodialysis patients.

Materials and methods: The participants were enrolled and then divided into the AST-120 treatment group and control group with a ratio of 2:1. All participants underwent pre-observation screenings two weeks before the study with three visits. In the treatment phase (week 1 to week 4), the treatment group added 6g/day of AST-120 along with routine anti-pruritic treatment. Visual analog scale (VAS) and biochemical parameters were measured.

Results: The VAS score began to be lower in the AST-120 treatment group after the 5th visiting (p < 0.05). The reduction in indoxyl sulfate (IS) at 5th week along with TNF-alpha. The reduction ratio of indoxyl sulfate correlated with reduction of parathyroid hormone.

Conclusion: This study has demonstrated that the four-week treatment of AST-120 decreased the severity of uremic pruritus in patients with ESRD. The concentration of IS and TNF-alpha decreased in the AST-120 treatment group. The reduction of iPTH correlated with the reduction of IS in the AST-120 treatment.

Keywords: AST-120; end-stage renal disease; indoxyl sulfate; protein bounded uremic toxin; uremic pruritus.

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Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no conflicts of interest related to this study.

Figures

Figure 1
Figure 1
The flow chart of the study. Abbreviation: ESRD: end stage renal disease.
Figure 2
Figure 2
The protocol of the clinical trial. The study was divided into three phases: (1) a pre-observation phase of two weeks; (2) a treatment phase of four weeks; (3) a post-observation phase of four weeks. All the participants received pre-observation screenings two weeks before the study with three visits. In the treatment phase, the control group received oral or parental antihistamine or topical cream/ointment for pruritus as routine anti-pruritic treatment according to the principle of each institute. For the intervention group added 6 g/day of AST-120 along with routine anti-pruritic treatment. In the treatment phase, the participants received two visits, in the 2nd and 4th weeks. In the post-treatment phase, the participants received two visits, in the 6th and 8th week.
Figure 3
Figure 3
The comparison of the VADS (A) and 5D itch scores (B) between the AST-120 group and control group from the 1st to 7th visit. *p < 0.05, AST-120 vs. control group at each visit.
Figure 4
Figure 4
The comparison of indoxyl sulfate (A), p-cresol sulfate (B), and TNF-α (C) levels between the AST-120 group and the control group from the 3rd to the 7th visit. *p < 0.05, when comparing 3rd visit for AST-120 group.
See this image and copyright information in PMC

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