Lubiprostone Shows Promise in Slowing Kidney Function Decline in Phase II CKD Trial

Key Insights

• A Phase II clinical trial demonstrated that lubiprostone, a constipation medication, suppressed kidney function decline in a dose-dependent manner in 150 patients with moderate chronic kidney disease.
• The study revealed that lubiprostone works by increasing spermidine production and promoting gut bacterial growth, which improves mitochondrial function and provides renoprotective effects.
• This represents the first time lubiprostone has been shown to prevent renal function decline in CKD patients, potentially offering a new therapeutic approach for a condition with limited treatment options.

A multicenter Phase II clinical trial has demonstrated that lubiprostone, a drug commonly used to treat constipation, can significantly slow the decline of kidney function in patients with chronic kidney disease (CKD). The breakthrough study, led by Professor Takaaki Abe from Tohoku University Graduate School of Medicine, represents the first evidence that this medication can prevent renal function deterioration in CKD patients.

Novel Therapeutic Approach Emerges from Gut-Kidney Connection

The research team's investigation stemmed from observing the frequent co-occurrence of constipation in CKD patients. "We noticed that constipation is a symptom that often accompanies CKD, and decided to investigate this link further," explains Professor Abe. "Essentially, constipation disrupts the intestinal microbiota, which worsens kidney function. Working backwards, we hypothesized that we could improve kidney function by treating constipation."

Phase II Trial Demonstrates Dose-Dependent Benefits

The LUBI-CKD TRIAL enrolled 150 patients with moderate CKD across nine Japanese medical institutions. Results showed that compared to the placebo group, patients treated with 8 µg or 16 µg of lubiprostone experienced suppressed decline in kidney function, measured as estimated glomerular filtration rate (eGFR), in a dose-dependent manner.

This finding is particularly significant given that despite CKD being a major global health issue requiring many patients to undergo regular dialysis, there are currently no drugs available that improve kidney function.

Mechanism Reveals Gut-Mitochondria-Kidney Axis

The researchers uncovered the underlying mechanism through which lubiprostone exerts its renoprotective effects. The drug increases spermidine production, which improves mitochondrial function by promoting bacterial growth in the gut. This enhanced mitochondrial function subsequently provides a renoprotective effect, suppressing further kidney damage.

Future Development and Clinical Implications

The research team plans to validate these results in a larger Phase III clinical trial and advance the exploration of biomarkers that predict treatment efficacy. Their goal is to provide personalized treatment plans tailored to individual CKD patients' needs.

This discovery has the potential to significantly transform conventional CKD treatment approaches, which primarily focus on reducing uremic toxins. The findings suggest a new therapeutic strategy where laxatives suppress renal function decline, with implications extending beyond CKD to mitochondrial dysfunction disorders.

The study results were published in Science Advances on August 30, 2025, marking a potential paradigm shift in nephrology treatment approaches.