Naslov
Transient renal dysfunction during INF-free therapy in decompensated HCV cirrhosis patients

Autori
Carey, Ivana ; Verma, Suman ; Mrzljak, Anna ; Considine, Aisling B ; Knighton, Sarah ; Oakes, Kath ; Childs, Kate ; Bruce, Matthew J ; Horner, Mary ; Suddle, Abid ; Agarwal, Kosh

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Hepatology / Nathanson, Michael - : John Wiley & Sons, 2015, 758A-758A

Skup
The 66th Annual Meeting of the American Association for the Study of Liver Diseases: The Liver Meeting 2015

Mjesto i datum
San Francisco (CA), Sjedinjene Američke Države, 13.11.2015. - 17.11.2015

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
renal dysfunction ; INF-free therapy ; HCV cirrhosis

Sažetak
Transient renal dysfunction occurs in 5-7% HCV patients treated with triple antiviral peg-IFN based therapy. Similarly Coilly at al reported transient decline in estimated glomerular filtration (eGFR) in cohort of post-transplant HCV patients treated with IFN-free (sofosbuvir (SOF) + daclatasvir (DCV) +/- RBV). On- treatment changes in specific renal markers cystatin C (glomerular function) and neutrophil gelatinase-associated lipocalin (NGAL) (tubular function), used in diagnosis of acute kidney injury, enhanced therapy delivery in patients on triple antiviral therapy. There are no data on cystatin C and NGAL levels changes during IFN- free therapy in HCV patients with decompensated cirrhosis (Child-Pugh B ≥7). Aim: Retrospective cross-sectional single centre study to investigate on-treatment changes in cystatin C and NGAL levels and correlate with changes in eGFR and presence/absence of proteinuria during IFN-free therapy for 12 weeks (SOF/ledipasvir+RBV or SOF+DCV+RBV) in HCV patients with decompensated cirrhosis. Patients: 52 patients with HCV decompesnated cirrhosis (median age 57years, 33 males, median MELD 11) underwent 12 weeks of therapy with IFN-free DAA regimen (86% SOF/ ledipasvir+ RBV and 14% SOF+DCV+RBV) and completed 12 weeks post-therapy follow-up. Material and Methods: Plasma levels of cystatin C, NGAL and renin at baseline, treatment week 4 (TW4), end of therapy (EoT), follow-up week 4 (FUW4) and follow-up week 12 (FUW12) were measured by ELISA and compared with eGFR and urinary protein creatinine ratio (uPCR) at the same time-points. Patients were stratified according to pre-existing renal risks (RR) (hypertension, diabetes, diuretics, tacrolimus). The results are presented as medians. Results: 50% patients had renal risk ; 16 hypertension, 10 diabetes, 26 therapy with diuretics and 6 received tacrolimus. At baseline 14% of patients had eGFR<60 and 10% patients had uPCR>15 and these proportions did not change significantly during therapy and follow up. eGFR did not change significantly during therapy and was lower in RR than non-RR patients (74 vs. 93min/ml, p=0.02). Cystatin C and NGAL levels were higher in RR patients and increased during the first 4 weeks of therapy in all patients (TW0 vs. TW4- cystatin C: 1.46 vs. 1.55mg/l, p<0.01 ; NGAL: 28.1 vs. 32.8 ng/ml, p<0.01). Renin levels fluctuated during therapy, but were similar in RR and non-RR patients. Conclusions: Although eGFR did not change significantly during IFN- free therapy in patients with HCV decompensated cirrhosis, more sensitive early markers of renal dysfunction cystatin C and NGAL had increased in the first 4 weeks of therapy indicating transient renal dysfunction

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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