Direct-acting antiviral agents in the treatment of chronic hepatitis C in dialysis patients


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Abstract

HCV infection is common among patients on program hemodialysis, and it has a poor prognosis and a high risk of rejection of the renal transplant. The possibility of treatment of HCV infection with interferons in such patients is limited, and the effectiveness of interferon-based antiviral therapy is low. Aim. To evaluate the efficacy and safety of asunaprevir and daclatasvir for dialysis patients with HCV infection. Material and methods. Six patients (5 with severe hepatic fibrosis) received daclatasvir (60 mg once a day) and asunaprevir (100 mg twice daily) for 24 weeks. Inclusion criteria: severe stage of liver fibrosis, or Child-Pugh class a hepatic cirrhosis (HC), and/or presence in kidney transplant waiting list. Serum concentration of HCV-RNA was determined to assess efficacy. Safety control was performed by determining alt, Ast, platelet levels. The examination was carried out at 2nd, 4th, 8th, 12th, 24th week immediately before the hemodialysis procedure. Patients were followed up for 12 weeks after completing the aVT, followed by evaluation of SVR, liver fibrosis dynamics, alt, AST and platelet levels. Results. Chronic glomerulonephritis was the reason for the development of end stage renal disease (ESRD) in 4 patients; one patient suffered from diabetic nephropathy, and another one had systemic lupus erythematosus. Three patients had a medical history of kidney allotransplantation, and four were in the waiting list. The HC was diagnosed in four patients, one patients was diagnosed with a severe stage of liver fibrosis (F3). Four patients had portal hypertension in the form of splenomegaly, and three of them had varicose veins of the esophagus. In patients with HC, the synthetic function of the liver was normal. Four patients had thrombocytopenia. All 6 (100%) patients achieved SVR. Against the background of eradication of HCV, a decrease in the transaminase levels, normalization of platelets and a decrease in the degree of fibrosis and stiffness of the liver were observed.

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About the authors

O. S Arisheva

SBHCI "City clinical hospital № 52” of Moscow Healthcare Department; FSAEI HE "Peoples' Friendship University of Russia"

Email: olga.arisheva@yandex.ru
PhD in Medical Science, Teaching Assistant at the Department of Internal Diseases with the Course of Cardiology and Functional Diagnostics FSAEI HE PFUR, Therapeutist of the Consulting and Diagnostic Nephrological Department SBHCI "CCH № 52 of Moscow Healthcare Department"

A. S Larchenko

SBHCI "City clinical hospital № 52” of Moscow Healthcare Department; FSAEI HE "Peoples' Friendship University of Russia"

Email: annanefro@mail.ru
Teaching Assistant at the Department of Hospital Therapy with Courses of Endocrinology, Hematology and Clinical Diagnostics FCME MI PFUR, Nephrologist at the 3rd Nephrological Department SBHCI "CCH № 52 of Moscow Healthcare Department"

A. I Ushakova

SBHCI "City clinical hospital № 52” of Moscow Healthcare Department

Nephrologist of the highest qualification category, Head of the 3rd Nephrological Department

O. N Kotenko

SBHCI "City clinical hospital № 52” of Moscow Healthcare Department; FSAEI HE "Peoples' Friendship University of Russia"

Email: olkotenko@yandex.ru
PhD in Medical Sciences, Associate Professor at the Department of Hospital Therapy with a Course of Hematology FSAEI HE PFUR, Chief External Expert-Nephrologist of Moscow Healthcare Department, Deputy Chief Physician for Nephrology SBHCI "CCH № 52 of Moscow Healthcare Department"

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