{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:42:20Z","timestamp":1760060540000,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Spherical Adsorptive Carbon (SAC), a type of oral sorbent, is prescribed to chronic kidney disease (CKD) patients to remove uremic toxins. However, evidence regarding its effectiveness in delaying chronic kidney disease (CKD) progression remains insufficient. We aimed to evaluate the impact of SAC on CKD progression in patients with CKD stage 3 or higher using nationwide data. In this retrospective cohort study, we included patients diagnosed with CKD stage \u22653 from the Korea National Health Insurance System database between January 2020 and December 2022. Outcomes were compared between SAC users (N = 1289) and non-users (N = 1289) after 1:1 propensity score matching (PSM). After PSM, the time from index date to end-stage kidney disease (ESKD) was significantly longer in the SAC user group compared to the non-user group (246.8 days vs. 118.6 days, p &lt; 0.001). In Cox regression analysis, the risk of ESKD was significantly lower in the SAC group (HR = 0.37, 95% CI: 0.29\u20130.48). However, the risk of dialysis initiation did not show a significant difference between the two groups (HR = 0.83, 95% CI: 0.27\u20132.59). This nationwide cohort study suggests that SAC treatment may delay progression from CKD stage 3 to ESKD, although it did not significantly reduce the risk of dialysis initiation.<\/jats:p>","DOI":"10.3390\/ijerph22091365","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T08:28:15Z","timestamp":1756715295000},"page":"1365","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Spherical Adsorptive Carbon Among Chronic Kidney Disease Patients: A Nationwide Cohort Study"],"prefix":"10.3390","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-2120-3263","authenticated-orcid":false,"given":"Dong Hui","family":"Shin","sequence":"first","affiliation":[{"name":"Department of Nephrology, Comprehensive Kidney Disease Research Institute, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keunryul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Comprehensive Kidney Disease Research Institute, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3689-5865","authenticated-orcid":false,"given":"Jae Won","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Comprehensive Kidney Disease Research Institute, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8047-4190","authenticated-orcid":false,"given":"Jun Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Comprehensive Kidney Disease Research Institute, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hill, N.R., Fatoba, S.T., Oke, J.L., Hirst, J.A., O\u2019Callaghan, C.A., Lasserson, D.S., and Hobbs, F.D.R. (2016). Global prevalence of chronic kidney disease\u2013a systematic review and meta-analysis. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0158765"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"473","DOI":"10.7326\/M16-0273","article-title":"Trends in prevalence of chronic kidney disease in the United States","volume":"165","author":"Murphy","year":"2016","journal-title":"Ann. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"933","DOI":"10.4093\/dmj.2020.0156","article-title":"Trends in the Incidence, Prevalence, and Mortality of End-Stage Kidney Disease in South Korea","volume":"44","author":"Lee","year":"2020","journal-title":"Diabetes Metab. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1093\/ndt\/gfz137","article-title":"SGLT-2 inhibitors and GLP-1 receptor agonists for nephroprotection and cardioprotection in patients with diabetes mellitus and chronic kidney disease. A consensus statement by the EURECA-m and the DIABESITY working groups of the ERA-EDTA","volume":"35","author":"Sarafidis","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.ekir.2023.10.006","article-title":"Updates on New Therapies for Patients with CKD","volume":"9","author":"Tarun","year":"2024","journal-title":"Kidney Int. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1080\/0886022X.2018.1561376","article-title":"Review of the efficacy of AST-120 (KREMEZIN\u00ae) on renal function in chronic kidney disease patients","volume":"41","author":"Asai","year":"2019","journal-title":"Ren. Fail."},{"key":"ref_7","first-page":"S23","article-title":"The protein metabolite hypothesis, a model for the progression of renal failure: An oral adsorbent lowers indoxyl sulfate levels in undialyzed uremic patients","volume":"62","author":"Niwa","year":"1997","journal-title":"Kidney Int. Suppl."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.ijcard.2014.09.196","article-title":"Impact of the oral adsorbent AST-120 on oxidative stress and uremic toxins in high-risk chronic kidney disease patients","volume":"177","author":"Toyoda","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000168716","article-title":"Progression of glomerular sclerosis in experimental uremic rats by administration of indole, a precursor of indoxyl sulfate","volume":"14","author":"Niwa","year":"1994","journal-title":"Am. J. Nephrol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1053\/j.ajkd.2005.12.036","article-title":"A multicenter, randomized, double-blind, placebo-controlled, dose-ranging study of AST-120 (Kremezin) in patients with moderate to severe CKD","volume":"47","author":"Schulman","year":"2006","journal-title":"Am. J. Kidney Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1159\/000357641","article-title":"Effects of AST-120 on blood concentrations of protein-bound uremic toxins and biomarkers of cardiovascular risk in chronic dialysis patients","volume":"37","author":"Lee","year":"2014","journal-title":"Blood Purif."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.metabol.2010.01.023","article-title":"Oral adsorbent AST-120 ameliorates tubular injury in chronic renal failure patients by reducing proteinuria and oxidative stress generation","volume":"60","author":"Nakamura","year":"2011","journal-title":"Metabolism"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2215\/CJN.12011214","article-title":"A Randomized, Controlled Trial of Oral Intestinal Sorbent AST-120 on Renal Function Deterioration in Patients with Advanced Renal Dysfunction","volume":"11","author":"Cha","year":"2016","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2014008","DOI":"10.4178\/epih\/e2014008","article-title":"A guide for the utilization of Health Insurance Review and Assessment Service National Patient Samples","volume":"36","author":"Kim","year":"2014","journal-title":"Epidemiol. Health"},{"key":"ref_15","first-page":"65","article-title":"Early morphological changes of tubules in rats with chronic renal failure","volume":"34","author":"Okada","year":"1992","journal-title":"Nihon Jinzo Gakkai Shi"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1159\/000112823","article-title":"Indoxyl sulfate reduces superoxide scavenging activity in the kidneys of normal and uremic rats","volume":"28","author":"Owada","year":"2008","journal-title":"Am. J. Nephrol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"F1551","DOI":"10.1152\/ajprenal.00281.2004","article-title":"Indoxyl sulfate induces complex redox alterations in mesangial cells","volume":"290","author":"Gelasco","year":"2006","journal-title":"Am. J. Physiol. Renal. Physiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1046\/j.1523-1755.2003.00906.x","article-title":"Uremic toxins of organic anions up-regulate PAI-1 expression by induction of NF-kappaB and free radical in proximal tubular cells","volume":"63","author":"Motojima","year":"2003","journal-title":"Kidney Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1159\/000324885","article-title":"Indoxyl sulfate downregulates renal expression of Klotho through production of ROS and activation of nuclear factor-kB","volume":"33","author":"Shimizu","year":"2011","journal-title":"Am. J. Nephrol."},{"key":"ref_20","first-page":"179","article-title":"Indoxyl sulfate and progression of renal failure: Effects of a low-protein diet and oral sorbent on indoxyl sulfate production in uremic rats and undialyzed uremic patients","volume":"23","author":"Niwa","year":"1997","journal-title":"Miner. Electrolyte Metab."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"180","DOI":"10.2119\/2005-00034.Ueda","article-title":"Oral adsorbent AST-120 decreases serum levels of AGEs in patients with chronic renal failure","volume":"12","author":"Ueda","year":"2006","journal-title":"Mol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1159\/000186222","article-title":"Inhibitory effect of oral sorbent on accumulation of albumin-bound indoxyl sulfate in serum of experimental uremic rats","volume":"57","author":"Niwa","year":"1991","journal-title":"Nephron"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1159\/000190236","article-title":"Effect of oral adsorbent on the progression of diabetic nephropathy","volume":"76","author":"Okada","year":"1997","journal-title":"Nephron"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1159\/000064291","article-title":"Effects of oral adsorbent AST-120 (Kremezin) on renal function and glomerular injury in early-stage renal failure of subtotal nephrectomized rats","volume":"91","author":"Kobayashi","year":"2002","journal-title":"Nephron"},{"key":"ref_25","first-page":"S188","article-title":"Effects of oral adsorbent AST-120 on the progression of chronic renal failure: A randomized controlled study","volume":"63","author":"Owada","year":"1997","journal-title":"Kidney Int. Suppl."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1093\/ndt\/gfp007","article-title":"Oral charcoal adsorbent (AST-120) prevents progression of cardiac damage in chronic kidney disease through suppression of oxidative stress","volume":"24","author":"Fujii","year":"2009","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1189\/jlb.0112023","article-title":"Reduction of indoxyl sulfate by AST-120 attenuates monocyte inflammation related to chronic kidney disease","volume":"93","author":"Ito","year":"2013","journal-title":"J. Leukoc. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000077536","article-title":"Oral ADSORBENT AST-120 decreases carotid intima-media thickness and arterial stiffness in patients with chronic renal failure","volume":"27","author":"Nakamura","year":"2004","journal-title":"Kidney Blood Press. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1007\/s00380-015-0785-7","article-title":"Long-term effects of AST-120 on the progression and prognosis of pre-dialysis chronic kidney disease: A 5-year retrospective study","volume":"31","author":"Sato","year":"2016","journal-title":"Hear. Vessel."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lee, C.-L., Liu, W., and Tsai, S.-F. (2024). Effects of AST-120 on mortality in patients with chronic kidney disease modeled by artificial intelligence or traditional statistical analysis. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-51498-6"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1080\/08860220802356531","article-title":"AST-120 treatment in pre-dialysis period affects the prognosis in patients on hemodialysis","volume":"30","author":"Ueda","year":"2008","journal-title":"Ren. Fail."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"376128","DOI":"10.1155\/2012\/376128","article-title":"Effect of an oral adsorbent, AST-120, on dialysis initiation and survival in patients with chronic kidney disease","volume":"2012","author":"Hatakeyama","year":"2012","journal-title":"Int. J. Nephrol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1053\/j.ajkd.2009.05.011","article-title":"Effect of a carbonaceous oral adsorbent on the progression of CKD: A multicenter, randomized, controlled trial","volume":"54","author":"Akizawa","year":"2009","journal-title":"Am. J. Kidney Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1681\/ASN.2014010042","article-title":"Randomized Placebo-Controlled EPPIC Trials of AST-120 in CKD","volume":"26","author":"Schulman","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1159\/000489772","article-title":"Importance of AST-120 (Kremezin\u00ae) Adherence in a Chronic Kidney Disease Patient with Diabetes","volume":"8","author":"Tomino","year":"2018","journal-title":"Case Rep. Nephrol. Dial."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/9\/1365\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:35:58Z","timestamp":1760034958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/9\/1365"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,30]]},"references-count":35,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ijerph22091365"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22091365","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2025,8,30]]}}}