Role of AST120 for Sarcopenia Prevention in Pre-dialysis Chronic Kidney Disease

Skeletal muscle atrophy, referred to as sarcopenia, and impaired physical performance are accompanied in chronic kidney disease patients during disease progression. Decreased physical performance derived from sarcopenia precipitates poor prognostic influence in the clinical outcome, as reported in previous studies showing correlations between poor physical performance, poor quality of life, poor renal prognosis, and mortality. Therefore, maintaining physical performance is mandatory to improve the prognosis of chronic kidney disease patients.

AST-120 is an oral absorbent capsule designed to remove circulating indoxyl sulfate, a uremic toxin. As indoxyl sulfate is reported to cause mitochondrial dysfunction in skeletal muscle, AST-120 contributes to the recovery of mitochondrial function by reducing indoxyl sulfate. In addition, AST-120 is reported to delay the initiation of dialysis and the decrease of glomerular filtration rate and the increase of serum creatinine level. However, the effect of AST-120 on sarcopenia in pre-dialysis patients have not been reported. This study is to investigate the effect of AST-120 on sarcopenia prevention in pre-dialysis chronic kidney disease patients.

Inclusion criteria

• Adult older than 19 years
• Pre-dialysis chronic kidney disease
• Serum creatinine level 2.0-5.0 mg/dL or MDRD or CKD-EPI eGFR 15-60 mL/min/1.73 m²
• Serum albumin ≥ 3.0 g/dL
• No previous use of oral absorbant during 4 weeks prior to screening
• No change of treatment for chronic kidney disease during 4 weeks prior to screening
• Written informed consent to participate in this clinical study
• Capable of independent physical activity, an assisted device use is acceptable

Exclusion criteria

• Impaired GI peristalsis
• Uncontrolled constipation
• Prior renal transplant
• On immunosuppressant (small dose users may be accepted according to the PI's decision)
• GI ulcer or esophageal varix
• Uncontrolled hypertension (systolic BP ≥180 mmHg or diastolic BP ≥110 mmHg)
• History of admission for an acute cardiovascular incident within 3 months prior to screening
• Current acute infection state
• Liver function failure (ALT, AST over 2.5 times of normal reference range)
• Uncontrolled diabetes patient (HbA1c >10 % or fasting glucose >250 mg/dL)
• Malignancy (patients of post-remission 5 years without any recurrence can be enrolled, except for squamous cell carcinoma in situ)
• Pregnancy, on breastfeeding
• Not agreed to medical contraceptive use during participating in the study
• Concurrent participation in another clinical trial
• Drug or alcohol-dependent
• Other clinical trial medication administration more than once within 30 days prior to enrollment
• Expected dialysis or kidney transplantation within 3 months prior to enrollment
• Dependent physical activity
• Musculoskeletal disease that may debilitate functional independence
• Lower limb amputee not using a prosthesis
• Severe retinal disease (e.g., proliferative diabetic retinopathy, vitreous hemorrhage)
• Claudication
• Other patients inappropriate to participate by the PI's decision