The number of patients with chronic kidney disease (CKD) is increasing. Oral toxin adsorbents may provide some value. Several uremic toxins, including indoxyl sulfate (IS), p‐cresol (PCS), acrolein, per‐ and poly‐fluoroalkyl substances (PFAS), and inflammation markers (interleukin 6 [IL‐6] and tumor necrosis factor [TNF]‐alpha) have been shown to be related to CKD progression. A total of 81 patients taking oral activated charcoal toxin adsorbents (AC‐134), which were embedded in capsules that dissolved in the terminal ileum, three times a day for 1 month, were recruited. The renal function, hemoglobulin (Hb), inflammation markers, three PFAS (PFOA, PFOS, and PFNA), and acrolein were quantified. Compared with the baseline, an improved glomerular filtration rate (GFR) and significantly lower acrolein were noted. Furthermore, the CKD stage 4 and 5 group had significantly higher concentrations of IS, PCS, IL‐6, and TNF but lower levels of Hb and PFAS compared with the CKD Stage 3 group at baseline and after the intervention. Hb was increased only in the CKD Stage 3 group after the trial (p = .032). Acrolein did not differ between the different CKD stage groups. Patients with improved GFR (responders) (about 77%) and nonresponders had similar baseline GFR. Responders had higher acrolein and PFOA levels throughout the study and a more significant reduction in acrolein, indicating a better digestion function. Responders had higher acrolein and PFOA levels throughout the study and a more significant reduction in acrolein, while PFOA increased in responders. Both the higher PFOA and lower acrolein may be related to improved eGFR (and possibly to improvements in proteinuria, which we did not measure. Proteinuria is associated with PFAS loss in the urine), AC‐134 showed the potential to improve the GFR and decrease acrolein, which might better indicate renal function change. Future studies are needed with longer follow‐ups.

中文翻译：

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肾毒素如何应对肾功能恶化和pH控释胶囊中口服毒性吸附剂

患有慢性肾脏病（CKD）的患者数量正在增加。口腔毒素吸附剂可能具有一定的价值。几种尿毒症毒素，包括硫酸吲哚酚 (IS)、对甲酚 (PCS)、丙烯醛、全氟烷基物质和多氟烷基物质 (PFAS) 以及炎症标记物（白细胞介素 6 [IL-6] 和肿瘤坏死因子 [TNF]- α）已被证明与 CKD 进展相关。总共招募了 81 名患者，口服活性炭毒素吸附剂（AC-134），将其嵌入胶囊中溶解在回肠末端，每天 3 次，持续 1 个月。对肾功能、血球蛋白 (Hb)、炎症标志物、三种 PFAS（PFOA、PFOS 和 PFNA）以及丙烯醛进行定量。与基线相比，肾小球滤过率（GFR）有所改善，丙烯醛显着降低。此外，与 CKD 3 期组相比，在基线和干预后，CKD 4 期和 5 期组的 IS、PCS、IL-6 和 TNF 浓度显着较高，但 Hb 和 PFAS 水平较低。试验后，仅 CKD 3 期组的 Hb 有所增加（p=.032）。不同 CKD 阶段组之间的丙烯醛没有差异。 GFR 改善的患者（有反应者）（约 77%）和无反应者的基线 GFR 相似。在整个研究过程中，应答者的丙烯醛和 PFOA 水平较高，并且丙烯醛含量下降更显着，表明消化功能更好。在整个研究过程中，应答者的丙烯醛和 PFOA 水平较高，并且丙烯醛的减少更为显着，而应答者中的 PFOA 则有所增加。较高的 PFOA 和较低的丙烯醛可能与 eGFR 的改善有关（也可能与蛋白尿的改善有关，我们没有测量蛋白尿。蛋白尿与尿液中 PFAS 的损失有关），AC-134 显示出改善 GFR 并降低肾小球滤过率 (GFR) 的潜力。丙烯醛，这可能更好地表明肾功能的变化。未来的研究需要更长的随访时间。