Outcomes
In pooling the included studies, the effect of AST-120 on the following
primary outcomes was determined: mortality, incidence of ESRD
(initiation of renal replacement therapy), and doubling of serum
creatinine. The effect of AST-120 on the secondary outcomes of interest
were not evaluated due to the paucity of data in the retrieved clinical
trials. Likewise, the intended analyses on the prespecified
subpopulations were forgone due to the lack of pertinent data in the
included studies.
In terms of the outcome of all-cause mortality, four trials were pooled,
with a resulting total population size of 1503 in the interventional
group and 1494 in the control group. There were a total of 110
mortalities in the interventional group and 116 mortalities in the
control group, yielding a risk ratio (RR) and 95% confidence interval
(CI) of 0.94 [0.74, 1.21]. This finding suggests that AST-120,
compared to standard treatment, has no effect on the outcome of
mortality among patients with CKD. The Forest plot for this primary
outcome is shown in Figure 3 .
Regarding the effect of AST-120 on the initiation of RRT, the pooled
data shows that there were 353 events out of a total sample size of 1524
in the interventional group while there 374 events out of a total
population of 1517 in the control group. This gives a risk ratio with
95% CI of 0.94 [0.83, 1.07] with no heterogeneity. This finding
suggests that AST-120 confers no significant benefit in preventing or
delaying the incidence of ESRD or initiation of RRT among adults with
CKD (Figure 4) .
Lastly, in terms of the effect of AST-120 on the doubling of serum
creatinine, four trials were pooled, giving a total population of 1503
in the interventional group and 1494 in the control group. There were a
total of 155 incidences of doubling of serum creatinine in the AST-120
group and also 155 incidences in the control group. This yields a risk
ratio with 95% CI of 0.99 [0.80, 1.22] with no heterogeneity,
suggesting that AST-120 has no significant effect on the outcome of
doubling of serum creatinine (Figure 5 ).
Pooled analysis on the adverse events associated with AST-120 cannot be
generated from the studies included in this review due to inadequate
recording and differences in reporting of adverse events. In general,
usual adverse effects reported in the studies are gastrointestinal in
nature.