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Introduction: Hepatitis C virus (HCV) infection is strongly associated with chronic kidney disease (CKD). It is an independent risk factor for developing CKD and significantly increases morbidity and mortality in CKD patients. Treatment with newer direct-acting antiviral (DAA) regimens in patients with CKD is showing conflicting results as regards safety and efficacy. Objectives: To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and Methods: We conducted a prospective observational study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (Faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens (sofosbuvir/daclatasvir with or without ribavirin and ombitasvir/paritaprevir/ritonavir [OMV/PTV/RTV] with ribavirin), completed over six months follow up. Serum creatinine, estimated glomerular filtration rate (eGFR), and proteinuria were followed during and after treatment. Results: Sustained virological response (SVR) was achieved in all patients. Improvement of eGFR (8-15 mL/min/1.73 m2) and proteinuria was found in both study groups. Acute kidney injury (AKI) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%). Conclusion: DAA regimens were effective and well-tolerated for HCV infected patients with stage 3-4 CKD, where viral clearance caused improvement in eGFR and proteinuria. [ABSTRACT FROM AUTHOR]

Background: Hepcidin, an acute phase reactant protein produced in the liver, is a key regulator of iron homeostasis. Because of its renal elimination and regulation by inflammation, it is possible that progressive renal insufficiency leads to altered hepcidin metabolism. Aim of the work: to assess effect of HCV treatment on hepcidin levels in regular heamodialysis patients and its relation to iron status. Patients and Methods: This cross sectional study was conducted on 45 ESRD patients on regular hemodialysis. All candidates included in this study subjected to careful history taking, full clinical examination and investigations (including complete blood count, HCVAb, HBVsAg and HIVAb). All patients had positive antibodies for hepatitis C; however, all of them had negative PCR and negative HIV, HBV antibodies. Results: In our study, dry weight ranged from 46 to 117 kg with mean 77.36. Weight gain ranged from 2 to 5 kg with mean 3.09.About 87% of patients had LTAVF access. About 12 patients (27%) received blood transfusion once. Timing of transfusion ranged from 4 to 60 month with median of 24 months. Regarding frequency of epoetin dose, 11 patients (24.4%) did not receive epoetin, 16 patients (35.6%) received it twice/week. Only 3 patients (6.7%) received iron therapy for time ranging from 3 to 5 months with mean of 4 months. Mean Hb concentration in our study population was 10.11 61.64 gm/dl. The mean of iron was 64.22 619.52, TIBC was 409.96 667.85, ferritin was 394.56 6 239.22 and TSAT% was 22.6 67.36. The mean serum hepcidin was 218.51 6127. Our study demonstrated that increase in serum hepcidin is associated with lower serum Hb and iron levels. On the other hand, there is statistically significant positive correlation between serum hepcidin and both serum ferritin and transferrin saturation. Conclusion: Median hepcidin value is elevated in dialysis ESRD patients due to increased inflammation and decreased clearance of hepcidin. Also serum hepcidin levels were lowered in HCV patients. Therefore ESRD patients on maintenance HD after treatment of HCV infection showed elevated levels of serum hepcidin. [ABSTRACT FROM AUTHOR]

Introduction: Despite the significant link between HCV and CKD progression, most of the patients with CKD infected with HCV remain untreated, because they have historically been difficult to treat due to common adverse effects associated with inter- feron (IFN), ribavirin, and first generation protease inhibitors. Recently, there have been major advancements in the treatment of HCV with the development of new directacting antivirals (DAAs). Objectives: To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and Methods: We conducted a prospective observatio- nal study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens, com- pleted over six months follow up. Kidney function was followed during and after treatment. Results: Sustained virological response (SVR) was achieved in all patients. AKI (acute kidney injury) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%). Improvement of eGFR (8-15 ml/min/1.73 m²) and proteinuria was found in both study groups. Conclusion: DAAs were effective and welltolerated for HCV infected patients with stage 3-4 chronic kidney disease, where viral clearance caused improvement in eGFR and proteinuria. [ABSTRACT FROM AUTHOR]