Abstract
Hemodialysis has been recognized to provide effective therapy for patients with chronic renal failure, meantime the increasing number of patients for hemodialysis has, however, raised new problems in economical and social points of view. One of the ways to solve the problems is therapy prior to hemodialysis, for supressing progression of disease and for retarding time to introduce patients into hemodialysis. For this purpose, carbonaceous adsorbent developed for oral use (AST-120) was subjected to clinical study; the results obtained so far were summerized.
Under conservative therapy for chronic renal failure, the adsorbent was administered at doses of 3-12g/day to 42 patients with serum creatinine levels of 4.3-13mg/dl. Clinical courses were followed at least for 6 months or until hemodialysis was introduced. Serum biochemical parameters and periods until hemodialysis were also examined. The results were evaluated in comparison with control data taken from natural history in 37 patients without the adsorbent therapy in the same hospitals.
During continuous treatment for 3-39 months, reduction of the increasing rate of creatinine levels (Cr) was observed in many cases. This was most clearly demonstrated in slope of regression line in 1/Cr vs time plot; the average slope during the adsorbent therapy was found to be much smaller than the slope before the therapy in the same patients and in the control data. Improvement of symptoms and reduction of abnormal peaks in serum analysis by liquid chromatography were also observed in some cases. The average periods from stages of creatinine levels of 6 and 8mg/dl to hemodialysis were 12±2.2, 8.3±0.9 months, respectively, in the patients under the adsorbent therapy. These periods were found to be clearly prolonged over the control data, 5.8±0.8, 2.6±0.5 months, respectively. Side effect attributable to the adsorbent was not experienced so far.
Those results led to the conclusion that the oral adsorbent therapy could retard time to introduce patients into hemodialysis, presumably by removing toxic metabolites such as uremic toxins at least in part. Further study is in progress.
