AST-120 (Kremezin): A Comprehensive Monograph on the Oral Carbon Adsorbent for Chronic Kidney Disease and Beyond

Introduction and Drug Profile

Overview of AST-120

AST-120 is an orally administered intestinal sorbent developed and innovated by Kureha Corporation in Japan.[1] Marketed under the brand name Kremezin®, it represents a unique therapeutic approach within the field of nephrology.[4] Its primary approved indication in several Asian countries is to slow the progression of chronic kidney disease (CKD), delay the initiation of maintenance dialysis, and ameliorate the systemic symptoms of uremia in patients with progressive CKD.[4] Pharmacologically, it is classified as an adsorbent for chronic kidney disease, functioning not through systemic absorption but by sequestering specific molecules within the gastrointestinal lumen.[9]

The development of AST-120 was driven by the understanding that the accumulation of certain gut-derived uremic toxins plays a direct role in the pathophysiology of CKD progression and its associated cardiovascular complications. By targeting the precursors of these toxins at their source within the intestine, AST-120 aims to interrupt a key pathological feedback loop where the consequences of renal failure (toxin accumulation) actively contribute to further renal and systemic damage. This upstream intervention distinguishes it from renal replacement therapies like dialysis, which attempt to clear toxins after they have entered the systemic circulation.

Physicochemical Properties