Ahmed Yahia Elmowafy1, Hanzada Mohamed El Maghrabi1,2, Mohamed Elsayed Mashaly1, Khaled Farouk Eldahshan1, Lionel Rostaing3,4, Mohamed Adel Bakr1. 1. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. 2. Nephrology Department, Port-Said University, Port Fuad, Egypt. 3. Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, CS 10217, 38043, Grenoble Cedex 09, France. lrostaing@chu-grenoble.fr. 4. Université Grenoble Alpes, Grenoble, France. lrostaing@chu-grenoble.fr.
Abstract
BACKGROUND: Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min. AIM: The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD. METHODS: Eighteen CKD stage 2-3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them. RESULTS: The patients'age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33-12.97); p = 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84-29.35); p = 0.001]. CONCLUSION: Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.
BACKGROUND: Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min. AIM: The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD. METHODS: Eighteen CKD stage 2-3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them. RESULTS: The patients'age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33-12.97); p = 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84-29.35); p = 0.001]. CONCLUSION: Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.
Authors: S B Willemse; L C Baak; S D Kuiken; A van der Sluys Veer; K D Lettinga; J T M van der Meer; A C T M Depla; H Tuynman; C M J van Nieuwkerk; C J Schinkel; D Kwa; H W Reesink; M van der Valk Journal: J Viral Hepat Date: 2016-07-13 Impact factor: 3.728
Authors: P Badri; S Dutta; E Coakley; D Cohen; B Ding; T Podsadecki; B Bernstein; W Awni; R Menon Journal: Am J Transplant Date: 2015-02-23 Impact factor: 8.086
Authors: Kris V Kowdley; Eric Lawitz; Fred Poordad; Daniel E Cohen; David R Nelson; Stefan Zeuzem; Gregory T Everson; Paul Kwo; Graham R Foster; Mark S Sulkowski; Wangang Xie; Tami Pilot-Matias; George Liossis; Lois Larsen; Amit Khatri; Thomas Podsadecki; Barry Bernstein Journal: N Engl J Med Date: 2014-01-16 Impact factor: 91.245