AST-120 improves microvascular endothelial dysfunction in end-stage renal disease patients receiving hemodialysis

Jung Hwa Ryu, Mina Yu, Sihna Lee, Dong Ryeol Ryu, Seung Jung Kim, Duk Hee Kang, Kyubok Choi

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Purpose: Endothelial dysfunction (ED) is a pivotal phenomenon in the development of cardiovascular disease (CVD) in patients receiving hemodialysis (HD). Indoxyl sulfate (IS) is a known uremic toxin that induces ED in patients with chronic kidney disease. The aim of this study was to investigate whether AST-120, an absorbent of IS, improves microvascular or macrovascular ED in HD patients. Materials and Methods: We conducted a prospective, case-controlled trial. Fourteen patients each were enrolled in respective AST-120 and control groups. The subjects in the AST-120 group were treated with AST-120 (6 g/day) for 6 months. Microvascular function was assessed by laser Doppler flowmetry using iontophoresis of acetylcholine (Ach) and sodium nitroprusside (SNP) at baseline and again at 3 and 6 months. Carotid arterial intima-media thickness (cIMT) and flow-mediated vasodilation were measured at baseline and 6 months. The Wilcoxon rank test was used to compare values before and after AST-120 treatment. Results: Ach-induced iontophoresis (endothelium-dependent response) was dramatically ameliorated at 3 months and 6 months in the AST-120 group. SNP-induced response showed delayed improvement only at 6 months in the AST-120 group. The IS level was decreased at 3 months in the AST-120 group, but remained stable thereafter. cIMT was significantly reduced after AST-120 treatment. No significant complications in patients taking AST-120 were reported. Conclusion: AST-120 ameliorated microvascular ED and cIMT in HD patients. A randomized study including a larger population will be required to establish a definitive role of AST-120 as a preventive medication for CVD in HD patients.

Original languageEnglish
Pages (from-to)942-949
Number of pages8
JournalYonsei Medical Journal
Volume57
Issue number4
DOIs
StatePublished - Jul 2016

Keywords

  • AST-120
  • Endothelial dysfunction
  • Hemodialysis
  • Indoxyl sulfate
  • Laser-Doppler flowmetry
  • Microvascular circulation

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