Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Egyptian Liver Research Institute and Hospital, Mansoura, Egypt.
Int Urol Nephrol. 2021 Apr;53(4):749-761. doi: 10.1007/s11255-020-02656-y. Epub 2020 Oct 27.
BACKGROUND/AIM: Chronic hepatitis-C infection is a great health burden in Egypt. The effect of anemia on the efficacy and safety of direct-acting anti-viral (DAA) therapies for those with chronic-kidney disease (CKD) has not been evaluated.
PATIENTS/METHODS: This single-center retrospective study included 235 renal patients: i.e., 70-CKD patients not on hemodialysis (42 with anemia, 28 without); 40 hemodialysis patients (16 anemic; 24 non-anemic), and 125 kidney-transplant (KTx) recipients (40 anemic; 85 non-anemic). Anemia was defined by a hemoglobin level < 10.5 g/dL. Hemodialysis patients received ritonavir-boosted paritaprevir/ombitasvir. KTx patients received sofosbuvir/daclatasvir. CKD patients with eGFR > 30 mL/min/1.73 m received sofosbuvir/daclatasvir. Those with eGFR < 30 mL/min/1.73 m received ritonavir-boosted paritaprevir/ombitasvir; 64 non-anemic patients also received ribavirin therapy.
Mean age of CKDs was 49.1 years, 43.2 years for HDs, and 45.2 years for KTx patients. Most were male; body-mass index was ~ 23.8. Anemia did not affect the efficacy of DAAs in hemodialysis, CKD, or KTx patients. Most patients achieved a rapid virologic response (RVR), and a 12- and 24-week sustained viral response. Worsening of anemia among the non-anemic group was mostly related to ribavirin therapy in hemodialysis patients (11/16 patients). Acute kidney injury in CKDs occurred more frequently within the anemic group (59.5%) compared to the non-anemic group (32.1%). For KTx, graft impairment was more common among the anemic group (7/40) compared to the non-anemic group (2/85).
Hemoglobin levels of < 10.5 g/dL prior to DAA treatment did not affect the virological response in renal patients but was associated with increased serum creatinine among KTx and those with CKD.
背景/目的：慢性丙型肝炎感染在埃及是一个严重的健康负担。贫血对慢性肾病（CKD）患者直接作用抗病毒（DAA）治疗的疗效和安全性的影响尚未得到评估。
患者/方法：本单中心回顾性研究纳入了 235 名肾病患者：即 70 名未接受血液透析的 CKD 患者（42 名贫血，28 名非贫血）、40 名血液透析患者（16 名贫血，24 名非贫血）和 125 名肾移植（KTx）受者（40 名贫血，85 名非贫血）。贫血定义为血红蛋白水平<10.5g/dL。血液透析患者接受利托那韦增强的帕利昔韦/奥米他韦治疗。KTx 患者接受索非布韦/达卡他韦治疗。eGFR>30mL/min/1.73m 的 CKD 患者接受索非布韦/达卡他韦治疗。eGFR<30mL/min/1.73m 的患者接受利托那韦增强的帕利昔韦/奥米他韦治疗；64 名非贫血患者还接受利巴韦林治疗。
CKD 患者的平均年龄为 49.1 岁，血液透析患者为 43.2 岁，KTx 患者为 45.2 岁。大多数患者为男性，体重指数约为 23.8。贫血并不影响血液透析、CKD 或 KTx 患者的 DAA 疗效。大多数患者达到快速病毒学应答（RVR）和 12 周和 24 周持续病毒学应答。非贫血组贫血加重主要与血液透析患者的利巴韦林治疗有关（16 例患者中有 11 例）。与非贫血组（32.1%）相比，贫血组的 CKD 急性肾损伤更常见（59.5%）。对于 KTx，贫血组（7/40）比非贫血组（2/85）更常见移植物损害。
DAA 治疗前血红蛋白水平<10.5g/dL 不影响肾病患者的病毒学反应，但与 KTx 和 CKD 患者的血清肌酐升高有关。
