Ken Sugimoto    Department   Kawasaki Medical School  Kawasaki Medical School, Department of General Geriatric Medicine,    Position   Professor
Article types	原著
Language	English
Peer review	Peer reviewed
Title	A Randomized Trial of Magnesium Oxide and Oral Carbon Adsorbent for Coronary Artery Calcification in Predialysis CKD.
Journal	Formal name：Journal of the American Society of Nephrology : JASN Abbreviation：J Am Soc Nephrol ISSN code：15333450/10466673
Domestic / Foregin	Foregin
Volume, Issue, Page	30(6),pp.1073-1085
Author and coauthor	Sakaguchi Yusuke, Hamano Takayuki, Obi Yoshitsugu, Monden Chikako, Oka Tatsufumi, Yamaguchi Satoshi, Matsui Isao, Hashimoto Nobuhiro, Matsumoto Ayumi, Shimada Karin, Takabatake Yoshitsugu, Takahashi Atsushi, Kaimori Jun-Ya, Moriyama Toshiki, Yamamoto Ryohei, Horio Masaru, Yamamoto Koichi, Sugimoto Ken, Rakugi Hiromi, Isaka Yoshitaka
Publication date	2019/06
Summary	BACKGROUND:Developing strategies for managing coronary artery calcification (CAC) in patients with CKD is an important clinical challenge. Experimental studies have demonstrated that magnesium inhibits vascular calcification, whereas the uremic toxin indoxyl sulfate aggravates it.METHODS:To assess the efficacy of magnesium oxide (MgO) and/or the oral carbon adsorbent AST-120 for slowing CAC progression in CKD, we conducted a 2-year, open-label, randomized, controlled trial, enrolling patients with stage 3-4 CKD with risk factors for CAC (diabetes mellitus, history of cardiovascular disease, high LDL cholesterol, or smoking). Using a two-by-two factorial design, we randomly assigned patients to an MgO group or a control group, and to an AST-120 group or a control group. The primary outcome was percentage change in CAC score.RESULTS:We terminated the study prematurely after an interim analysis with the first 125 enrolled patients (of whom 96 completed the study) showed that the median change in CAC score was significantly smaller for MgO versus control (11.3% versus 39.5%). The proportion of patients with an annualized percentage change in CAC score of ≥15% was also significantly lower for MgO compared with control (23.9% versus 62.0%). However, MgO did not suppress the progression of thoracic aorta calcification. The MgO group's dropout rate was higher than that of the control group (27% versus 17%), primarily due to diarrhea. The percentage change in CAC score did not differ significantly between the AST-120 and control groups.CONCLUSIONS:MgO, but not AST-120, appears to be effective in slowing CAC progression. Larger-scale trials are warranted to confirm these findings.
DOI	10.1681/ASN.2018111150
PMID	31036759