New oral spherical carbon adsorbent effectively reduces serum indoxyl sulfate levels in moderate to advanced chronic kidney disease patients: a multicenter, prospective, open-label study

BackgroundElevated levels of serum indoxyl sulfate (IS) have been linked to cardiovascular complications in patients with chronic kidney disease (CKD). Oral sorbent therapy using spherical carbons selectively attenuates IS accumulation in CKD patients. This study aimed to investigate whether oral administration of a new oral spherical carbon adsorbent (OSCA), reduces serum IS levels in moderate to severe CKD patients.MethodsThis prospective, multicenter, open-label study enrolled patients with CKD stages 3-5. Patients were prescribed OSCA for 8weeks (6g daily in 3 doses) in addition to standard management. Serum IS levels were measured at baseline and 4 and 8weeks of treatment with OSCA.ResultsA total of 118 patients were enrolled and 87 eligible patients completed 8weeks of study. The mean age of the study subjects was 62.813.7years, and 80.5% were male. Baseline levels of serum IS were negatively correlated with estimated glomerular filtration rate (eGFR) (r=-0.406, P<0.001) and increased with increasing CKD stages (stage 3, 0.210.21mg/dL; stage 4, 0.54 +/- 0.52mg/dL; stage 5, 1.15 +/- 054mg/dL; P for trend = 0.001). The patients showed significant reduction in serum total IS levels as early as 4weeks after OSCA treatment (22.5 +/- 13.9% reduction from baseline, P<0.001) and up to 8weeks (31.9 +/- 33.7% reduction from baseline, P<0.001). This reduction effect was noted regardless of age, kidney function, or diabetes. No severe adverse effects were reported. Gastrointestinal symptoms were the most commonly reported adverse effects. In total, 21 patients withdrew from the study, with dyspepsia due to heavy pill burden as the most common reason. The medication compliance rate was 84.7 +/- 21.2% (min 9%, max 101%) for 8weeks among those who completed the study.Conclusions OSCA effectively reduced serum IS levels in moderate to severe CKD patients. Gastrointestinal symptoms were the most commonly reported complications, but no treatment-related severe adverse effects were reported.Trial registration Clinical Research Information Service (KCT0001875. 14 December 2015.)