Effectiveness of AST-120 and probiotics ( lactobacillus ) on renal function in patients with chronic kidney disease: A retrospective cohort study from the TriNetX global collaborative network

Objective Chronic kidney disease (CKD) progression has been associated with the accumulation of protein-bound uremic toxins (PBUTs), such as indoxyl sulfate and p-cresyl sulfate. AST-120, an oral carbon adsorbent, and probiotics (e.g., Lactobacillus ) have been used in clinical practice to modulate PBUT burden, but comparative real-world data on long-term outcomes remain limited. Methods We conducted a retrospective, multinational study using de-identified electronic health records from TriNetX Global Collaborative Network. Adult patients (≥18 years) with baseline estimated glomerular filtration rate <60 mL/min/1.73 m 2 who received AST-120 or Lactobacillus between January 2001 and July 2025 were identified. After 1:1 propensity score matching on 16 baseline covariates, 340 patients were included in each group. Primary outcomes were progression to stage 4 or 5 CKD, end-stage kidney disease (ESKD), and all-cause mortality. Time-to-event analyses were performed using Cox proportional hazards models. Results Over mean follow-up of 2.3 years, AST-120 use was associated with lower risks of progression to stage 4 CKD (HR 0.294; 95% CI 0.148–0.586), stage 5 CKD (HR 0.488; 95% CI 0.296–0.805), ESKD (HR 0.333; 95% CI 0.168–0.663), and all-cause mortality (HR 0.508; 95% CI 0.351–0.735), compared with a probiotic-exposed reference cohort. The composite outcome of ESKD or mortality showed a similar association. Conclusions In this propensity score–matched real-world cohort, AST-120 use was associated with more favorable renal and survival outcomes compared with a probiotic-exposed reference population. Given the observational design and potential for residual confounding, these findings should be interpreted as hypothesis-generating.