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

How to delay the progression of chronic kidney disease: focusing on medications. (PubMed, Child Kidney Dis) - "Tolvaptan, a selective vasopressin V2-receptor antagonist, decelerates the rate of increase in total kidney volume and deterioration of kidney function in patients with rapidly progressive autosomal dominant polycystic kidney disease. The protective effects of AST-120 remain controversial. Due to a lack of evidence regarding the efficacy and safety of these medications in children, it is imperative to weigh the benefits and adverse effects carefully. Further research is essential to establish the efficacy and safety profiles in pediatric populations."

Journal • Review • Autosomal Dominant Polycystic Kidney Disease • Cardiovascular • Chronic Kidney Disease • Fibrosis • Genetic Disorders • Hematological Disorders • Hypertension • Immunology • Inflammation • Nephrology • Pediatrics • Polycystic Kidney Disease • Renal Disease

Response to Comment on "Long-term effect of AST-120 on delaying renal replacement therapy initiation in CKD: A propensity score overlap-weighted retrospective cohort study". (PubMed, J Formos Med Assoc) - No abstract available

Journal • Retrospective data

Comment on "Long-term effect of AST-120 on delaying renal replacement therapy initiation in CKD: A propensity score overlap-weighted retrospective cohort study". (PubMed, J Formos Med Assoc) - No abstract available

Journal • Retrospective data

Response to "Rethinking endpoints, subgroup analyses, and time-varying treatment in AST-120 CKD research". (PubMed, J Formos Med Assoc) - No abstract available

Journal

Indoxyl Sulfate Contributes to Progression of Renal Injury in the Postpartum Period Following Pregnancy-Related Acute Kidney Injury. (PubMed, Toxins (Basel)) - "Postpartum reduction in IS with AST-120 dampens the progression of renal injury. These findings highlight uremic toxins as mechanistic drivers and potential therapeutic targets in post partum CKD following PR-AKI."

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

Rethinking endpoints, subgroup analyses, and time-varying treatment in AST-120 CKD research. (PubMed, J Formos Med Assoc) - No abstract available

Journal

Long-term effect of AST-120 on delaying renal replacement therapy initiation in CKD: A propensity score overlap-weighted retrospective cohort study. (PubMed, J Formos Med Assoc) - "AST-120 use was associated with lower long-term RRT risk, even after correcting for confounding by indication."

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

Effectiveness of AST-120 and probiotics (lactobacillus) on renal function in patients with chronic kidney disease: A retrospective cohort study from the TriNetX global collaborative network. (PubMed, Sci Prog) - "The composite outcome of ESKD or mortality showed a similar association.ConclusionsIn this propensity score-matched real-world cohort, AST-120 use was associated with more favorable renal and survival outcomes compared with a probiotic-exposed reference population. Given the observational design and potential for residual confounding, these findings should be interpreted as hypothesis-generating."

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

Chronic Exposure to NaAsO2 Induces Renal Fibrosis by Modulating Gut Microbiota-Mediated AhR/NLRP3 Inflammasome Signaling Pathway. (PubMed, J Agric Food Chem) - "Moreover, AST-120, a non-specific adsorbent, alleviated chronic NaAsO2 exposure-induced renal fibrosis by reducing the IS level in mice...Collectively, we confirmed that chronic exposure to NaAsO2 caused renal fibrosis and intestinal barrier dysfunction. Meanwhile, the gut-kidney axis plays a significant role in the mechanism of NaAsO2-induced renal fibrosis, providing a new therapeutic target for the prevention and treatment of arseniasis."

Journal • Fibrosis • Immunology • Nephrology • Renal Disease • Transplantation • NLRP3

Gut microbiota and the kidney-gut-skin axis in chronic kidney disease-associated pruritus: mechanisms and therapeutic implications. (PubMed, Front Cell Infect Microbiol) - "This review summarizes the traditional pathogenic mechanisms of CKD-aP, reviews recent advances linking gut microbial alterations to pruritus-related pathways, and systematically evaluates gut-targeted and metabolism-targeted interventions, including probiotics, prebiotics, synbiotics, AST-120, fecal microbiota transplantation, phytochemicals, Uremia Clearance Granules, and vitamin D-related strategies...Accordingly, gut microbiome-related mechanisms and interventions remain hypothetical and adjunctive, without established causal relationships or validated standard therapies for CKD-aP. Future studies are required to identify CKD-aP-specific pathological alterations, adopt longitudinal design and multi-omics analysis, conduct mechanistic verification, and perform randomized controlled trials with pruritus as a predefined primary endpoint."

Journal • Review • Chronic Kidney Disease • Dermatology • Inflammation • Metabolic Disorders • Nephrology • Pruritus • Renal Disease • Transplantation

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