Kozielewicz Dorota, Dybowska Dorota, Karwowska Kornelia, Wietlicka-Piszcz Magdalena
a Department of Infectious Diseases and Hepatology, Faculty of Medicine , Nicolaus Copernicus University in Toruń , Bydgoszcz , Poland.
b Department of Theoretical Foundations of Biomedical Sciences and Medical Computer Science , Faculty of Pharmacy, Nicolaus Copernicus University in Toruń , Bydgoszcz , Poland.
Expert Opin Drug Saf. 2015;14(12):1815-25. doi: 10.1517/14740338.2015.1102882. Epub 2015 Oct 29.
The incidence, course and risk factors associated with renal impairment (RI) in patients treated with triple therapy (TT) with pegylated interferon, ribavirin and telaprevir/boceprevir (PR/TVR/BOC) vs. dual therapy (DT) with PR were analyzed in this study. The association between RI and the decline of hemoglobin (Hb) was also examined.
Retrospective analysis included 110 patients with genotype 1b chronic HCV infection, aged 18 - 80 years, who underwent TT (48TVR/14BOC) or DT (48 patients). The estimated glomerular filtration rate (eGFR), serum creatinine concentration (SCr) and Hb were measured at baseline, at weeks 4, 12, 24, 48 of treatment, and post-treatment week 24.
RI occurred in 9/62 (14.5%) patients who underwent TT, eight of whom were treated with TVR, one with BOC, and none treated with DT. The risk factors associated with RI were the following: TT (p = 0.0078), usage of nephrotoxic drugs (p = 0.0288), and older age (p < 0.0001). RI was reversible. A drop of Hb was associated with RI, older age and TT.
RI is not a rare but a reversible complication of TT. It is necessary to monitor SCr and eGFR, especially in patients with a potential risk factor of RI occurrence. The Hb drop is more severe in patients with RI than in those without it.
本研究分析了接受聚乙二醇化干扰素、利巴韦林和特拉匹韦/博赛泼维（PR/TVR/BOC）三联疗法（TT）与PR双联疗法（DT）治疗的患者中肾功能损害（RI）的发生率、病程及相关危险因素。还研究了RI与血红蛋白（Hb）下降之间的关联。
回顾性分析纳入了110例年龄在18至80岁之间的1b型慢性丙型肝炎病毒感染患者，这些患者接受了TT（48例使用TVR/14例使用BOC）或DT（48例）治疗。在基线、治疗第4、12、24、48周以及治疗后第24周测量估计肾小球滤过率（eGFR）、血清肌酐浓度（SCr）和Hb。
接受TT治疗的62例患者中有9例（14.5%）发生RI，其中8例接受TVR治疗，1例接受BOC治疗，接受DT治疗的患者无RI发生。与RI相关的危险因素如下：TT（p = 0.0078）、使用肾毒性药物（p = 0.0288）和年龄较大（p < 0.0001）。RI是可逆的。Hb下降与RI、年龄较大和TT有关。
RI并非TT罕见的并发症，而是可逆的。有必要监测SCr和eGFR，尤其是在有RI发生潜在危险因素的患者中。RI患者的Hb下降比无RI患者更严重。
