Kremezin (AST-120) / Tanabe Pharma, Kureha Corp - LARVOL DELTA

INDOXYL SULFATE DOWNREGULATES HEPATIC SEPP1 LEADING TO SELENIUM DEFICIENCY AND RENAL FERROPTOSIS (ISN-WCN 2026) - "Furthermore, reduced expression of the selenium-containing protein GPX4 and ferroptosis were observed in the renal tissue of CKD mice, both of which were suppressed by AST-120.Conclusion This study highlights the key role IS plays in Se deficiency and renal ferroptosis by suppressing hepatic SEPP1 expression. The findings suggest potential therapeutic strategies that target IS and Se deficiency for the management of CKD.Portions of this data were presented at The 68th Annual Meeting of the Japanese Society of Nephrology."

Chronic Kidney Disease • Nephrology • GPX4 • SELENOP

Gut Microbiota Dysbiosis Promotes CKD-associated Atrial Fibrillation Through Activation of the NLRP3 Inflammasome. (PubMed, Europace) - "This study demonstrates that gut dysbiosis-driven elevation of IS and subsequent activation of the atrial NLRP3 inflammasome are key mechanisms in CKD-associated AF. Modulating the gut microbiota could provide a new therapeutic strategy for CKD-associated AF."

Journal • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Gastrointestinal Disorder • Nephrology • Renal Disease • Transplantation • NLRP3 • TLR4

Indoxyl Sulfate in the Gut-Kidney Axis: Pathophysiology and Clinical Significance in CKD-Associated Colorectal Cancer. (PubMed, Toxins (Basel)) - "We also discuss the repurposing of the oral adsorbent AST-120 and emerging bacteriophage therapies as strategies to disrupt this oncogenic axis. This review offers a comprehensive framework for stratified management of CKD-associated CRC."

Journal • Review • Chronic Kidney Disease • Colorectal Cancer • Nephrology • Oncology • Renal Disease • Solid Tumor • KRAS • MYC • SDC2 • SEPTIN9

Uremic Pruritus in Hemodialysis: Mechanisms, Burden, and Emerging Therapies. (PubMed, J Clin Med) - "Sertraline, nalbuphine, and difelikefalin showed significant antipruritic effects in controlled trials. Emerging therapies, including AST-120, omega-3 fatty acids, and the biologic dupilumab, demonstrated promising but preliminary results. Management of uremic pruritus requires a multifaceted, individualized approach integrating skin-directed therapies, dialysis optimization, and targeted systemic treatments. Ongoing research is needed to identify reliable biomarkers and to develop safer, more effective, mechanism-based therapies."

Journal • Review • Dermatology • Nephrology • Pediatrics • Pruritus • Renal Disease

Effect of AST-120 treatment discontinuation and serum albumin on free and bound indoxyl sulphate in end-stage kidney disease. (PubMed, Int J Clin Pharmacol Ther) - "AST-120 in ESKD patients has profound effects on the disposition of IS. There are important sources of variability having a possible marked effect on the concentration of IS in patients with chronic kidney disease. Discontinuing AST-120 treatment before hemodialysis, a practice in Japan to avoid the "off-label" administrations of the agent, will result in high and variable concentrations of uremic toxins such as IS. The consequences of this effect will include progression of the disease and the occurrence of cardiovascular and neurological degeneration."

Journal • Cardiovascular • Chronic Kidney Disease • Nephrology • Renal Disease

New insights in the chronic kidney disease-associated osteoarthritis progression: Role of uremic toxin indoxyl sulfate-induced chondrocyte senescence and ferroptosis. (PubMed, Life Sci) - "Our findings demonstrate for the first time that IS promotes both calcium influx and iron accumulation, leading to enhanced chondrocyte lipid peroxidation, senescence and ferroptosis. These effects may underlie the mechanistic link between CKD and OA comorbidity. IS may thus represent a critical bridge between kidney dysfunction and joint degeneration."

Journal • Chronic Kidney Disease • Hematological Disorders • Immunology • Nephrology • Osteoarthritis • Pain • Renal Disease • Rheumatology • CAPN1

Targeting gut-liver-kidney axis: microbiota-derived metabolites and therapeutic implications. (PubMed, Cell Commun Signal) - "Finally, we propose a conceptual "diet-microbiota-drug" triad to guide precision interventions, and discuss current challenges such as interindividual variability, the lack of standardized assessment tools, and the need for integrative multi‑omics and clinical validation. A deeper mechanistic understanding of gut-organ crosstalk may pave the way for innovative therapies to restore systemic metabolic homeostasis."

Journal • Review • Hepatology • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease • Transplantation

Clinical Pharmacokinetic-Pharmacodynamic Relationships of Pharmacological Strategies for Attenuating p-Cresyl Sulfate in Patients with Kidney Disease. (PubMed, Clin Pharmacokinet) - "The studies included AST-120 (n = 3), sevelamer (n = 9), sucroferric Noxyhydroxide (n = 1 [+ 1 overlapping with sevelamer]), prebiotics (n = 15), probiotics (n = 9), synbiotics (n = 13), antibiotics (n = 3), ketoanalogs (n=3), and curcumin (n = 3)...In contrast, the majority of sucroferric oxyhydroxide, prebiotics, probiotics, ketoanalogs, and curcumin studies did not demonstrate consistent pCS reductions...In Ngeneral, it was also difficult to establish associations with outcomes in most studies because of limitations in experimental design, and in instances where potential pharmacokinetic-pharmacodynamic relationships were observed, they were generally weak and only with surrogate markers of commonly measured biochemistry, oxidative stress, lipid profiles, and inflammatory markers, with only a handful of studies capturing clinical outcomes. In conclusion, we have identified potential pharmacological interventions that may be further developed for the purpose of..."

Journal • PK/PD data • Review • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Heart Failure • Myocardial Infarction • Nephrology • Renal Disease • Transplantation

Long-Term Renoprotective Effects of AST-120 (Kremezin) in Patients with CKD (KIDNEY WEEK 2025) - "Conclusion AST-120 demonstrated significant long-term renoprotective effects at 8 years in CKD stage 3-5 patients and at 10 years in CKD stage 4 patients. 8-Year Survival Free from ESRD or Mortality Risk of ESRD or Mortality at 8 and 10 Years"

Clinical • Chronic Kidney Disease • Nephrology • Renal Disease

Kidney Injury Following Pregnancy Related (PR)-AKI (KIDNEY WEEK 2025) - "A subset of rats were treated with an oral carbon absorbent, AST-120, which absorbs the precursor of indoxyl sulfate in the gut...In order to identify a safe therapeutic that can be administered during pregnancy, more experiments are needed to determine the exact role of indoxyl sulfate in the renal injury progression. We are currently examining the role of I.S. during pregnancy and the postpartum period."

Acute Kidney Injury • Cardiovascular • Chronic Kidney Disease • Fibrosis • Immunology • Inflammation • Nephrology • Obstetrics • Renal Disease • Reperfusion Injury

Unraveling the mysteries of the gut-kidney axis: the protective role of traditional Chinese medicine in chronic kidney disease. (PubMed, Front Microbiol) - "Contemporary therapeutic arsenals targeting this axis encompass probiotic reconstitution, prebiotic orchestration, synbiotic hybridization, precision nutritional calibration, and enteral sequestrants including AST-120...Sophisticated polyherbal architectures, exemplified by YQHG and YSHS, harmoniously fortify intestinal impermeability while nullifying uremic translocation. These revelations substantiate the transformative potential of integrative paradigms amalgamating TCM-based phytomedicine with microbiota-directed precision therapeutics for CKD stewardship."

Journal • Review • Chronic Kidney Disease • Gastrointestinal Disorder • Nephrology • Renal Disease

Stabilizing Mirizzi Syndrome With ERCP: Endoscopic Management as a Bridge to Delayed Cholecystectomy (ACG 2025) - "ALP 349 U/L, AST 120 U/L, ALT 228 U/L, total bilirubin 5.5 mg/dL, WBC 12.4 ×10⁹/L...Surgical management is challenging due to inflammation around the gallbladder neck, increasing the risk of bile duct injury during laparoscopic procedures. As seen in this case, endoscopic management with ERCP can provide symptomatic relief and diagnostic clarification in patients not suitable for immediate surgery.Figure: 7.28 mm Dilated CBD Found on MRCPFigure: Stenosis of the Common Hepatic Duct and Failure of Gallbladder Filling Seen on ERCP"

Addiction (Opioid and Alcohol) • Dermatology • Fibrosis • Gallbladder Cancer • Gastroenterology • Genetic Disorders • Hepatology • Immunology • Liver Failure • Pruritus • Solid Tumor

SPONTANEOUS PNEUMOTHORAX IN PARAQUAT POISONING: THE RARE BUT LETHAL DAISLEY-BARTON SYNDROME (CHEST 2025) - "Arterial blood gas (ABG) analysis demonstrated metabolic acidosis (pH-7.35, PaO₂-60 mmHg, HCO₃ mmol/L), and laboratory investigations indicated mild liver injury (AST-120 IU/L, ALT-98 IU/L) and acute kidney injury (creatinine-2.1 mg/dL, BUN-35 mg/dL)...High-resolution computed tomography (HRCT) of the chest showed diffuse bilateral ground-glass opacities (GGOs), consistent with acute lung injury.He was started on oxygen therapy, intravenous dexamethasone (6mg thrice daily), N-acetylcysteine (NAC), ceftriaxone (1g twice daily), and Vitamin C.On day three of hospitalization, the patient developed acute desaturation (SpO₂: 62%) despite supplemental oxygen and worsening tachypnea (RR: 40)... This case highlights the rare occurrence of spontaneous pneumothorax in paraquat poisoning, emphasizing the importance of early intervention, vigilant supportive care, and monitoring for late-onset complications to improve outcomes in fatal paraquat poisoning"

Acute Kidney Injury • Acute Lung Injury • Hepatology • Inflammation • Liver Failure • Metabolic Disorders • Nephrology • Renal Disease • Respiratory Diseases

HSD17B13 EXPRESSION IS INCREASED IN BALLOONED HEPATOCYTES FROM PATIENTS WITH STEATOTIC LIVER DISEASE (SLD) AND CAN BE THERAPEUTICALLY TARGETED BY GSK4532990 IN PATIENTS WITH ALCOHOL-ASSOCIATED LIVER DISEASE (ALD) (AASLD 2025) - P2 | "C-P A participants had ALT 55 (35–117) vs 39 (13–53) IU/L and AST 120 (180–73) vs 80 (144–53) IU/L, despite consistent alcohol consumption during follow-up (PEth 758 [427-1273] vs 796 [417–1169] µg/L) at baseline vs W8, (median [IQR]; Fig. HSD17B13 expression is increased in ballooned hepatocytes. Preliminary data from the ongoing STARLIGHT ALD study have not identified safety concerns from a single dose of GSK4532990. There was a trend toward reduced aminotransferases, despite ongoing alcohol consumption, that may correspond to improvements in hepatocyte ballooning."

Clinical • Addiction (Opioid and Alcohol) • Fibrosis • Hepatology • Immunology

ASTRA-AKD: AST-120 (Kremezin®) for the Renal Protection and Attenuation of Decline in Acute Kidney Disease (clinicaltrials.gov) - P4 | N=100 | Recruiting | Sponsor: Chang Gung Memorial Hospital

New P4 trial • Acute Kidney Injury • Nephrology • Renal Disease

Gut-derived uremic toxins and cardiovascular health in chronic kidney disease. (PubMed, Tzu Chi Med J) - "Recent trials have demonstrated the potential of agents such as sevelamer, high-amylose-resistant starch, and AST-120 to reduce UT levels and improve certain vascular markers. However, more robust, long-term studies are necessary to fully establish the therapeutic efficacy and optimize treatment strategies to mitigate the impact of gut-derived UTs on CKD and CV health."

Journal • Review • Cardiovascular • Chronic Kidney Disease • Gastrointestinal Disorder • Inflammation • Nephrology • Renal Disease

Adynamic bone disorder in chronic kidney disease: meta-analysis and narrative review of potential biomarkers as diagnosis and therapeutic targets. (PubMed, Ren Fail) - "Romosozumab, while effective, has safety concerns that limit its use. Uremic toxins are reduced by AST-120 treatment, which alleviates PTH hypo-responsiveness and bone toxicity. Adjunctive measures include addressing vitamin D deficiency, and diabetes, and utilizing antioxidant and anti-inflammatory therapies. Overall, BALP and iPTH appear as potential promising biomarkers for diagnosing and monitoring adynamic bone disorder in CKD, effectively guiding therapeutic interventions."

Biomarker • Clinical • Journal • Retrospective data • Review • Chronic Kidney Disease • Diabetes • Hypoparathyroidism • Inflammation • Metabolic Disorders • Nephrology • Orthopedics • Renal Disease

Effect of AST-120 and synbiotics on the gut microbiome in chronic kidney disease patients, a randomized-controlled trial: Non-dialysis CKD, Diabetic Kidney Disease (KSN 2025) - "These findings suggest that AST-120 and synbiotics may have a synergistic effect in modulating the gut microbiome, potentially leading to improved renal and systemic health outcomes in CKD patients. Result_histogram.png"

Clinical • Chronic Kidney Disease • Diabetic Nephropathy • Nephrology • Renal Disease • Sarcopenia

Death Crystals: Sign of Impending Doom (ATS 2025) - "Patient was initially admitted for nausea after her first cycle of carboplatin/etoposide/durvalumab...Liver function at arrival was AST 120 and ALT 16 with an INR of 4.6...Here, isolated elevation of INR preceded the discovery of the crystals and prompt treatment may have helped prevent imminent hemodynamic instability. Increased reporting of this phenomena will provide further data so the significance of these inclusion crystals can further be identified."

Chronic Obstructive Pulmonary Disease • Gastroenterology • Hepatology • Immunology • Liver Failure • Lung Cancer • Oncology • Respiratory Diseases • Small Cell Lung Cancer • Solid Tumor

Indoxyl Sulfate Contributes to Selenium Deficiency and Renal Ferroptosis by Decreasing the Expression of Selenium Transport Protein SEPP1. (PubMed, Kidney360) - "This study highlights the key role IS plays in selenium deficiency and renal ferroptosis by suppressing hepatic SEPP1 expression. The findings suggest potential therapeutic strategies that target IS and selenium deficiency for the management of CKD."

Journal • Chronic Kidney Disease • Nephrology • Renal Disease • AMPK • GPX4 • MIR34A

Uremic Toxins, Chronic Kidney Disease, and Cognitive Dysfunction. (PubMed, J Am Soc Nephrol) - "Reviewed therapeutic interventions include: AST-120 [indoxyl sulfate absorbent], CH-223191 [aryl hydrocarbon receptor antagonist], TRAM34 [Kca3.1-specific inhibitor], anakinra [IL-1R inhibitor], marimastat, exercise, supplements, and kidney transplantation. Finally, future research directions are suggested including targeting of cellular senescence abundance with senotherapeutics and capitalizing on anti-inflammatory effects of regenerative, cell-based therapeutics (e.g. mesenchymal stem cells and extracellular vesicles), and use of aged murine models. Collectively, CKD-associated cognitive impairment represents a prevalent condition for which remaining knowledge gaps exist, and scientific advancements are needed to preserve cognitive function and improve the lives of in individuals with CKD."

Journal • Alzheimer's Disease • Chronic Kidney Disease • CNS Disorders • Cognitive Disorders • Inflammation • Nephrology • Renal Disease • Transplantation • Vascular Neurology • IL1R1

Impact of using oral spherical carbon adsorbent in predialysis chronic kidney disease period on cardiovascular outcome after dialysis therapy. (PubMed, Sci Rep) - "The oral spherical carbon adsorbent (OSCA), AST-120, has demonstrated efficacy in slowing the progression of chronic kidney disease (CKD)...Additionally, the OSCA ≥ 4 months group experienced significantly fewer composite outcome (HR 0.46, 95% CI 0.24-0.90). These findings indicate that longer-term OSCA use before dialysis initiation could reduce cardiovascular events and death post-dialysis, suggesting a potential 'legacy effect'."

Journal • Retrospective data • Cardiovascular • Chronic Kidney Disease • Nephrology • Renal Disease

Mitochondrial dysfunction and mitophagy blockade contribute to renal osteodystrophy in chronic kidney disease-mineral bone disorder. (PubMed, Kidney Int) - "The altered p62 /SQSTM1 and LC3-II expression was consistent with impaired mitophagy machinery, and the effects of uremic toxins were reversible by rapamycin. A causal link between uremic toxins and the development of mitochondrial abnormalities and ROD was established by showing that a mitochondria-targeted antioxidant (MitoQ) and the charcoal adsorbent AST-120 were able to mitigate the uremic toxin-induced mitochondrial changes and improve bone health...Targeting uremic toxins, oxygen-free radical production and the mitophagy process may offer novel routes for intervention to preserve bone health in patients with CKD-MBD. This would be timely as our current armamentarium of anti-fracture medications for patients with severe CKD-MBD is limited."

Journal • Chronic Kidney Disease • Metabolic Disorders • Musculoskeletal Diseases • Nephrology • Orthopedics • Osteoporosis • Renal Disease • ATG7 • SQSTM1

The Ability of AST-120 to Lower the Serum Indoxyl Sulfate Level Improves Renal Outcomes and the Lipid Profile in Diabetic and Nondiabetic Animal Models of Chronic Kidney Disease: A Meta-Analysis. (PubMed, Toxins (Basel)) - "AST-120 lowered serum IS and triglyceride levels and improved renal function in animal models of CKD independent of diabetes status. However, AST-120's ability to lower the total cholesterol level was more prominent in animals with diabetic CKD."

Clinical • Journal • Preclinical • Retrospective data • Chronic Kidney Disease • Diabetes • Diabetic Nephropathy • Dyslipidemia • Metabolic Disorders • Nephrology • Renal Disease

Now You See Me, Now You Don't: Spontaneous Remission of HCC (ACG 2024) - "Labs were notable for chronic HBV co-infection with Hepatitis D, HBV viral load of 60 IU/mL, ALT 91 U/L, AST 120 U/L, total bilirubin 1.4 mg/dL, AFP of 1429 ng/mL...He was referred to medical oncology, who recommended lenvatinib for treatment of unresectable HCC...During this interval, he was started on entecavir 0.5 mg daily for treatment of chronic HBV...MRI abdomen in 11/2017 demonstrated a 93 mm, ill-defined heterogenous mass involving the right lobe of the liver, predominantly in segment 5, 6 and 8 (A). By 12/2018, this mass was no longer recognized (B), and remained as such in 12/2019 (C) and on most recent imaging in 11/2023 (D)."

Clinical • Hepatitis B • Hepatocellular Cancer • Hepatology • Immunology • Infectious Disease • Metabolic Disorders • Metabolic Dysfunction-Associated Steatohepatitis • Pain • Systemic Inflammatory Response Syndrome • Thrombosis • CD4 • IL2 • TNFA