Medicinal Charcoal for Chronic Kidney Disease: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

1. Tibet Autonomous Region People’s Hospital, Lahsa 850000,China2. Department of Geriatrics,West China Hospital,Sichuan University,Chengdu 610041,China.3. Tibet Autonomous Region in Chengdu Office’s Hospital,Chengdu 610041,China;

Corresponding author：

Keywords：

Medicinal charcoal; Chronic kidney disease; Randomized controlled trial; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20090239

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Objective 　To assess the efficacy and safety of prescribing medicinal charcoal for treatment of adult chronic kidney disease.
Methods 　We searched the Cochrane Controlled Trial Register (The Cochrane Library Issue 1, 2009), MEDLINE (1950 to January 2009), EMbase (1980 to January 2009), and Chinese Biomedical Database (1977 to January 2009) to screen randomized controlled trials (RCTs) concerning use of medicinal charcoal for treatment of adult chronic kidney disease. We evaluated the bias risk of the included RCTs according to the Cochrane Handbook for Systematic Reviews of Interventions Version 4.2.2.The Cochrane Collaboration’s software RevMan 5.0 was used for meta-analysis.
Results 　Seven trials involving 347 patients met the criteria. Meta-analysis showed: (1) Medicinal charcoal was better than routine treatment on the improvement of blood urea nitrogen [MD= –0.69, 95%CI (–1.13, –0.24), P=0.002], serum creatinine [MD= – 0.51, 95%CI (–0.94, – 0.08), P=0.02] and the mean change of glomerular filtration rate per month (P lt;0.001). Compared with routine treatment, medicinal charcoal had similar effects on the improvement of 24 hours urinary protein and the mean change of blood pressure; (2) Compared with placebo, and medicinal charcoal was not superior to placebo in improving the incidence of end stage kidney diseases, serum creatinine, creatinine clearance rate, 24 hour urinary protein (P gt;0.05); (3) Adverse events with constipation, flatulenceand nausea occurred to medicinal charcoal groups.
Conclusion 　Overall, the evidence is not b enough, and more large, high-quality randomized controlled trials are needed to confirm or refute the available evidence.

Citation： SUN Hongjuan,WU Hongmei,WANG Feng,LI Ting. Medicinal Charcoal for Chronic Kidney Disease: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(12): 1310-1314. doi: 10.7507/1672-2531.20090239 Copy

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2.	Fouque D, Laville M, Boissel JP. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database Systeamtic Review, 2006, 19: CD001892.
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6.	Owada A, Nakao M, Koike J. Effects of oral adsorbent AST-120 on the progression of chronic renal failure:A randomized controlled study. Kidney International, 1997, 52(Suppl 63): S188-S190.
7.	李彬, 张澎, 马秀琴. 医学活性炭保留灌肠治疗慢性肾功能衰竭短期疗效观察. 宁夏医学杂志, 2004, 12(26): 804.
8.	Sanaka T, Sugino N, Teraoka S, et al. Therapeutic Effects of Oral Sorbent in Undialyzed Uremia. Am J of Kidney Dis, 1988, 12(8): 97-103.
9.	Nakamura T, Kawagoe Y, Matsuda T. Oral Adsorbent AST-120 Decrsases Carotid Intima-Media Thickness and Thickness and Arterial Stiffness in Patients with Chronic Renal Failure. Kidney Blood Press Res, 2004, 27: 121-126.
10.	Shoji T, Wada A, Inoue K. Prospective randomized study evaluating the efficacy of the spherical adsorptive carbon ast-120 in chronic kidney disease patients with moderate decrease in renal function. Nephron Clin Pract, 2007, 105: c99-c107.
11.	Marier JF, James Lee, Rama S, et al. Effect of Repeated Oral Administrations of the Oral Adsorbent AST-120 on Serum Creatinine and Other Markers of Renal Function. Am J Nephrol, 2006, 26: 136-141.
12.	Schulman G, Agarwal R, Acharya M. A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study of AST-120 (Kremezin) in Patients With Moderate to Severe CKD. Am J of Kidney Dis, 2006, 47: 565-577.
13.	Taki K, Niwa T. Indoxyl sulfate-lowering capacity of oral sorbents affects the prognosis of kidney function and oxidative stress in chronic kidney disease. J Ren Nutr, 2007, 17(1): 48-52.
14.	Ueda H, Shibahara N, Takagi S, et al. AST-120 treatment in predialysis period affects the prognosis in patients on hemodialysis. Ren Fail, 2008, 30(9): 856-860.
15.	Yoshida Y, Tadasu S, Ise M. Effects of oral adsorbent in the rat model of chronic renal failure. Nephron, 1992, 62: 305-314.
16.	Takahashi T, Reed SD, Schulman KA. Cost-effectiveness of the oral adsorbent AST-120 versus placebo for chronic kidney disease. Nephrology (Carlton), 2008, 13(5): 419-427.

1. Brenner BM. Nephrology forum:hemodynamically mediated glomerular injury and the progressive nature of renal disease. Kidney Int, 1983, 23: 647-655.
2. Fouque D, Laville M, Boissel JP. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database Systeamtic Review, 2006, 19: CD001892.
3. 龚伟, 李世军, 王金泉. 血管紧张素转换酶抑制剂与血管紧张素Ⅱ受体拮抗剂; 何者对心肾的保护作用更强. 肾脏病与透析肾移植杂志, 2005, 14: 197-199.
4. National Kidney Foundation. DOQI kidney disease outcome quality initiative. Am J Kidney Dis, 2002, 39(Suppl 1): S1-S266.
5. Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001, 323(7303): 42-46.
6. Owada A, Nakao M, Koike J. Effects of oral adsorbent AST-120 on the progression of chronic renal failure:A randomized controlled study. Kidney International, 1997, 52(Suppl 63): S188-S190.
7. 李彬, 张澎, 马秀琴. 医学活性炭保留灌肠治疗慢性肾功能衰竭短期疗效观察. 宁夏医学杂志, 2004, 12(26): 804.
8. Sanaka T, Sugino N, Teraoka S, et al. Therapeutic Effects of Oral Sorbent in Undialyzed Uremia. Am J of Kidney Dis, 1988, 12(8): 97-103.
9. Nakamura T, Kawagoe Y, Matsuda T. Oral Adsorbent AST-120 Decrsases Carotid Intima-Media Thickness and Thickness and Arterial Stiffness in Patients with Chronic Renal Failure. Kidney Blood Press Res, 2004, 27: 121-126.
10. Shoji T, Wada A, Inoue K. Prospective randomized study evaluating the efficacy of the spherical adsorptive carbon ast-120 in chronic kidney disease patients with moderate decrease in renal function. Nephron Clin Pract, 2007, 105: c99-c107.
11. Marier JF, James Lee, Rama S, et al. Effect of Repeated Oral Administrations of the Oral Adsorbent AST-120 on Serum Creatinine and Other Markers of Renal Function. Am J Nephrol, 2006, 26: 136-141.
12. Schulman G, Agarwal R, Acharya M. A Multicenter, Randomized, Double-Blind, Placebo-Controlled, Dose-Ranging Study of AST-120 (Kremezin) in Patients With Moderate to Severe CKD. Am J of Kidney Dis, 2006, 47: 565-577.
13. Taki K, Niwa T. Indoxyl sulfate-lowering capacity of oral sorbents affects the prognosis of kidney function and oxidative stress in chronic kidney disease. J Ren Nutr, 2007, 17(1): 48-52.
14. Ueda H, Shibahara N, Takagi S, et al. AST-120 treatment in predialysis period affects the prognosis in patients on hemodialysis. Ren Fail, 2008, 30(9): 856-860.
15. Yoshida Y, Tadasu S, Ise M. Effects of oral adsorbent in the rat model of chronic renal failure. Nephron, 1992, 62: 305-314.
16. Takahashi T, Reed SD, Schulman KA. Cost-effectiveness of the oral adsorbent AST-120 versus placebo for chronic kidney disease. Nephrology (Carlton), 2008, 13(5): 419-427.

Chinese Journal of Evidence-Based Medicine

Medicinal Charcoal for Chronic Kidney Disease: A Systematic Review

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