Background
Chronic kidney disease (CKD), defined as kidney damage or decreased
kidney function for three or more months, is one of the leading causes
of morbidity and mortality worldwide.1,2 It is
associated with increased risk for cardiovascular events, frequent
hospitalization, and death.3,4,5 For end-stage renal
disease, the management is renal replacement therapy through dialysis or
kidney transplantation. Locally, in 2017, hemodialysis ranked as the top
procedure with the Philippine Health Insurance Corporation (PhilHealth)
paying a total of Php 8.4 billion worth of claims.6
Oral adsorbents, like AST-120, are substances that bind biologically
active compounds, such as uremic toxins, in the gastrointestinal tract.
Through binding and eventual excretion, they minimize the accumulation
of these toxins in the body. The levels of uremic toxins, such as
indoxyl sulfate and p -cresyl sulfate, in the body have been shown
to be associated with progression of CKD, increased cardiovascular risk,
and mortality.7,8,9,10 Worsening CKD will in turn
result in production of more uremic toxins leading to a vicious cycle.
AST-120 has been shown to decrease serum levels of indoxyl sulfate in
rats11,12 and delay progression of CKD in animals with
reduced kidney mass.13,14 Currently, based on several
studies,15,16,17 some of its suggested clinical
utilities among patients with chronic kidney disease (CKD) is to reduce
uremic symptoms and delay the progression to renal replacement therapy
and kidney transplantation.