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Research Paper|Volume 16, Issue 5|pp 4236—4249

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

Chia-Chao Wu1,2, Ya-Chung Tian3, Chien-Lin Lu4,5, Ming-Ju Wu6,7, Paik-Seong Lim8, Yi-Wen Chiu9,10, Ko-Lin Kuo11,12,13, Shou-Hsuan Liu14, Yu-Ching Chou15, Chien-An Sun16,17, Yi-Chou Hou4,18, Kuo-Cheng Lu11,19
  • 1Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
  • 2Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei 11490, Taiwan
  • 3Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan City 33303, Taiwan
  • 4School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
  • 5Division of Nephrology, Department of Medicine, Fu Jen Catholic University Hospital, New Taipei City 24352, Taiwan
  • 6Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
  • 7Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
  • 8Division of Nephrology, Department of Internal Medicine, Tungs’ Taichung Metroharbour Hospital, Taichung 43503, Taiwan
  • 9Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
  • 10Faculty of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
  • 11Division of Nephrology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 23142, Taiwan
  • 12School of Medicine, Buddhist Tzu Chi University, Hualien 97004, Taiwan
  • 13School of Post-Baccalaureate Chinese Medicine, Buddhist Tzu Chi University, Hualien 97004, Taiwan
  • 14Department of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City 33303, Taiwan
  • 15School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
  • 16Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
  • 17Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
  • 18Division of Nephrology, Department of Internal Medicine, Cardinal-Tien Hospital, New Taipei City 23155, Taiwan
  • 19Division of Nephrology, Department of Medicine, Fu-Jen Catholic University Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 24352, Taiwan
* Equal contribution
Received: September 14, 2023Accepted: January 17, 2024Published: February 21, 2024
https://doi.org/10.18632/aging.205580

Copyright: © 2024 Wu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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.