***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Increasing evidence suggests that circulating aldosterone per se contributes directly to renal and cardiovascular diseases . We sought to evaluate the effects of a three-month treatment with 25 mg spironolactone , an aldosterone receptor antagonist , on nephron function in 20 type II diabetic patients with persistent microalbuminuria , despite at least six months ' use of an ACEi or ARB ( combination group ) , and in eleven type II diabetic patients with persistent microalbuminuria who have never used an ACEi or an ARB ( spironolactone group ) . In the combination group , urinary protein excretion ( UPE , p = 0.015 ) , urinary albumin excretion ( UAE , p = 0.010 ) , and the urinary albumin to creatinine ratio ( ACR , p = 0.007 ) decreased , and serum potassium ( sK+ , p = 0.004 ) was significantly elevated . ACR ( p = 0.016 ) decreased significantly in the spironolactone group . In 31 patients given spironolactone ( all patients group ) , UPE ( p = 0.019 ) , UAE ( p = 0.002 ) , and ACR ( p = 0.011 ) decreased , and serum creatinine ( sCr , p = 0.025 ) and sK+ ( p = 0.002 ) were significantly elevated . Changes in albuminuria showed a positive correlation with changes in GFR ( p = 0.002 ) and a negative correlation with changes in sCr ( p = 0.007 ) , and changes in ACR showed a negative correlation with changes in sCr ( p = 0.004 ) in all patient groups . In our study , we observed that spironolactone , both alone and in combination with ACEi/ARB treatment , was well tolerated , and that it slowed down the progression of diabetic nephropathy with a marked antialbuminuric effect . Our results showed that the antialbuminuric effect developed by the decrease of intraglomerular pressure , particularly in patients with persistent microalbuminuria despite long-term ACEi/ARB treatment ; adding aldosterone blockers to treatment was beneficial Background / Aim : Intima media thickness ( IMT ) and stiffness of the carotid arteries is related to coronary artery disease , and chronic renal failure patients are at high risk for such diseases . An oral adsorbent , AST-120 ( Kremezin ; Kureha Chemical Industry , Tokyo , Japan ) , can delay the progression of chronic renal failure in undialyzed uremic patients . The aim of the present study was to determine whether AST-120 affects carotid artery IMT and pulse wave velocity ( PWV ) in patients with chronic renal failure not undergoing dialysis . Methods : Fifty patients with non-diabetic chronic renal failure were r and omly divided into two groups : 30 patients ( 18 men and 12 women ; mean age 53.5 years ; mean serum creatinine 3.2 mg/dl ) who were given AST-120 ( 6.0 g/day ) and 20 patients ( 12 men and 8 women ; mean age 52.0 years ; mean serum creatinine 3.5 mg/dl ) who were not given AST-120 . Thirty healthy age-matched subjects ( 18 men and 12 women ; mean age 51.5 years ; mean serum creatinine 0.9 mg/dl ) were also included . The treatment period was 24 months . IMT and arterial stiffness were measured before and after treatment . Results : The slope of the reciprocal serum creatinine concentration over time became significantly less steep in the AST-120 group than in the non-AST-120 group ( p < 0.001 ) . Before treatment , carotid artery IMT differed little between the AST-120 group ( 0.90 ± 0.22 mm ) and the non-AST-120 group ( 0.88 ± 0.20 mm ) . IMT in these two groups was significantly greater than IMT in the control group ( 0.64 ± 0.14 mm ) ( p < 0.01 ) . Carotid IMT in the AST-120 group decreased slightly but not significantly to 0.84 ± 0.20 mm after 12 months and then significantly after 24 months to 0.78 ± 0.18 mm ( p < 0.05 ) . Carotid IMT in the non-AST group showed little change throughout the experimental period . PWV differed little between the AST-120 group ( 1,980 ± 330 cm/s ) and the non-AST group ( 1,940 ± 360 cm/s ) before treatment . PWV values in these two groups were significantly greater than PWV in the control group ( 1,280 ± 240 cm/s ) ( p < 0.01 ) . After 12 and 24 months , PWV in the AST-120 group decreased significantly to 1,840 ± 280 cm/s ( p < 0.05 ) and to 1,780 ± 260 cm/s ( p < 0.05 ) , respectively ; however , PWV in the non-AST group showed a slight increase during the experimental period . Conclusion : The data suggest that AST-120 may reduce arterial stiffness and IMT in non-diabetic chronic renal failure patients before dialysis Background . Indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) are uraemic toxins that have similar protein binding , dialytic clearance and proinflammatory features . However , only a few prospect i ve studies have evaluated possible associations between these two retained solutes and renal disease progression in chronic kidney disease ( CKD ) patients . Methods . This prospect i ve observational study evaluated independent associations between serum total IS and PCS with renal progression in a selected cohort of patients having different stages of CKD .  Baseline PCS and IS were correlated with renal progression [ defined as decrements in estimated glomerular filtration rate ( eGFR ) > 50 % from baseline or progression to end-stage renal disease ( ESRD ) ] and death during a follow-up period of 24 months . Results . Of 268 patients , 35 ( 13.1 % ) had renal progression and 14 ( 5.2 % ) died  after a mean follow-up of 21 ± 3 months . Univariate Cox regression analysis followed by multivariate analysis showed that high-serum PCS levels were associated with renal progression and all-cause mortality independent of age , gender , diabetes status , albumin levels , serum IS , serum creatinine , Ca × P product , intact parathyroid hormone , haemoglobin or high-sensitivity C-reactive protein level . Serum IS was only associated with renal progression ; however , the predictive power of serum IS was weakened when serum PCS was also present in the analytical model . Conclusions . In addition to traditional and uraemia-related risk factors such as renal function , serum IS and PCS levels may help in predicting the risk of renal progression in patients having different stages of CKD AIM This study was design ed to evaluate the cost-effectiveness of AST-120 , an oral adsorbent that attenuates the progression of chronic kidney disease . METHODS We developed a Markov model with six health states , including four levels of serum creatinine , haemodialysis and death , using data from a r and omized clinical trial conducted in Japan . Direct costs relevant to chronic kidney disease were calculated from a Japanese reimbursement perspective . Projected quality -adjusted life years ( QALY ) and costs were compared between the AST-120 and placebo groups . The target population was nondiabetic patients with serum creatinine levels from 5.0 to 8.0 mg/dL ( 442 - 707 micromol/L ) at baseline . Probabilistic sensitivity analysis was performed to evaluate the stability of the results . RESULTS At 3 years , mean total costs per patient were estimated at 6.67 million yen ( US$ 56,982 ) in the AST-120 group and 9.38 million yen ( US$ 80,196 ) in the placebo group . Mean total costs were 2.72 million yen ( US$ 23,205 ) lower among patients receiving AST-120 . QALY per patient were 0.295 ( approximately 3.5 months ) greater for patients receiving AST-120 than for those receiving placebo over 3 years . The finding that treatment with AST-120 dominated placebo ( i.e. was less costly and result ed in more QALY ) was upheld in sensitivity analyses . CONCLUSION The use of AST-120 in patients with advanced chronic kidney disease may help to slow the rate of growth in expenditures for kidney disease Background The number of patients with chronic kidney disease ( CKD ) in Japan is currently rising . Therefore , measures to control the progression of CKD from a predialysis condition to endstage renal failure are urgently required . We are conducting a clinical trial to investigate the efficacy of an oral carbonaceous adsorbent ( Kremezin ) in patients at the predialysis stage of progressive chronic kidney disease ( the Carbonaceous oral Adsorbent 's effectiveness on Progression of chronic Kidney Disease [ CAP-KD ] trial ) . Methods A multidisciplinary treatment regimen , consisting of antihypertensive therapy ( using an angiotensin-converting-enzyme inhibitor and /or an angiotensin II receptor blocker ) and a low-protein diet is conventionally used to treat patients with kidney disease . To assess the efficacy of Kremezin in preventing the progression of CKD , we compare two groups of patients , receiving either conventional treatment alone or such treatment paired with Kremezin . The CAP-KD trial is a prospect i ve , multicenter , r and omized , open-label , two-arm , parallel-group comparison clinical trial and will be conducted as a research er-directed study . The primary endpoint of this study is the time to the first event of a composite endpoint , comprising the following : ( 1 ) a doubling of serum creatinine ( sCr ) ; ( 2 ) an increase in sCr level to 6.0 mg/dl or more ; ( 3 ) endstage renal disease ( defined as that requiring dialysis or renal transplantation ) ; and ( 4 ) death . Secondary endpoints are as follows : ( 1 ) variation in urinary protein ; ( 2 ) changes in creatinine clearance rate ; ( 3 ) changes in health-related quality of life ; and ( 4 ) adverse events .  The total number of patients ( putative ) in this trial will be 450 , with 225 patients in each group . Enrollment will take place over 2 years , with a 1-year follow-up period . Results As this is an ongoing trial , results are not yet available . Conclusions We believe that the CAP-KD trial is a well- design ed study that will provide internationally relevant evidence concerning the outcomes of treatment in Japanese patients with CKD This prospect i ve , r and omized controlled study was design ed to examine the effects of oral adsorbent AST-120 on the progression of chronic renal failure ( CRF ) in patients on a strict low protein diet ( LPD ) . Twenty-six patients with CRF ( serum creatinine 3.0 to 8.6 mg/dl ) on a LPD  were r and omly assigned to a control group ( N = 13 ) or an AST-120 group ( N = 13 ) . The 1/Cr slope and creatinine clearance ( CCr ) slope were used to estimate the progression rate of CRF ; uremic toxins , serum and urinary indoxyl sulfate ( IS ) , peak 2a and guanidino substrates ( GS ) measured by HPLC . Comparisons were made between the baseline observation period for 6 to 12 months and the treatment period ( 0.6 g/kg/day of LPD alone or concurrent with 6 g/day of AST-120 , for the control and the AST-120 groups , respectively ) for 12 to 24 months in both groups . Both the 1/Cr slope and CCr slope were significantly lessened in the treatment period only in the AST-120 group . Serum and urinary IS , but neither peak 2a nor GS were significantly decreased in the treatment period only in the AST-120 group . We conclude that AST-120 administration concurrent with LPD may be superior to LPD alone in retarding the progression of CRF by inhibiting accumulation of indoxyl sulfate Abstract Aims /hypothesisHigh-dose supplements of thiamine prevent the development of microalbuminuria in experimental diabetes . The aim of this pilot study was to assess whether oral supplements of thiamine could reverse microalbuminuria in patients with type 2 diabetes . Methods Type 2 diabetic patients ( 21 male , 19 female ) with microalbuminuria were recruited at the Diabetes Clinic , Sheikh Zayed Hospital , Lahore , Pakistan , and r and omised to placebo and treatment arms . R and omisation was by central office in sequentially numbered opaque , sealed envelopes . Participants , caregivers and those assessing the outcomes were blinded to group assignment . Patients were given 3 × 100 mg capsules of thiamine or placebo per day for 3 months with a 2 month follow-up washout period . The primary endpoint was change in urinary albumin excretion ( UAE ) . Other markers of renal and vascular dysfunction and plasma concentrations of thiamine were determined . Results UAE was decreased in patients receiving thiamine therapy for 3 months with 
    Output:
    
Compared with routine treatment , Niaoduqing granules had positive effects on reducing SCr ( MD -135.60 ( µmol/L ) , 95 % CI -198.03 to -73.17 ) and CrCl ( MD 13.30 ( mL/min ) , 95 % CI 5.69 to 20.91).The most commonly reported adverse events associated with AST-120 and Ai Xi Te were gastrointestinal symptoms however no serious adverse events were reported .
For our secondary outcomes , there is evidence of limited quality that AST-120 , Ai Xi Te and Niaoduqing granules may have positive effects on delaying the decline of kidney function .
There were no serious adverse events for any of the interventions in patients with CKD .
Given the lack of information for our primary outcomes , the low method ological quality of most studies , and the small sample sizes , there is no strong evidence on the effectiveness of these oral adsorbents