JLE

Néphrologie & Thérapeutique

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Sofosbuvir and daclatasvir combination therapy in hemodialysis patient with liver transplantation Volume 12, issue 7, Décembre 2016

Authors

Background

Vascular calcification (VC) is one of the factors associated with cardiovascular mortality in hemodialysis (HD) patients. Recommendations concerning screening for VC differ. Possible ability to prevent and reversibility of VC are major subjects on debate whether screening for VC could improve outcomes of renal patients. The objective of the study was to evaluate the significance of simple vascular calcification score (SVCS) based on plane radiographic films and to test its association with non-fatal cardiovascular events in patients on chronic HD.

Methods

A study population consisted of 95 prevalent HD patients in the HD unit of Hospital of Lithuanian University of Health sciences Kaunas Clinics. Clinical data and laboratory tests information were collected from medical records. SVCS was evaluated as it is described by Adragao et al. After measurement of VC, HD patients were observed for novel non-fatal cardiovascular events.

Results

Patients were divided into two groups: SVCS≥3 (57 patients [60%]) and <3 (38 patients [40%]). The Kaplan–Meier survival curves show a significant difference in non-fatal cardiovascular events in the group with SVCS≥3 vs. <3 group (26.3% vs. 7.8%; log rank 5,49; P=0.018). Multivariate Cox regression analysis confirmed a negative impact of VC, hyperphosphatemia, and lower ejection fraction on cardiovascular events. No statistically significant differences were observed comparing parameters of Ca-P metabolism disorders between groups with different SVCS. On separate analysis, the presence of VC in hands was also associated with higher rate of novel cardiovascular events (score 0 goup–5 events [10.6%] vs. score≥1 group–13 events [27%], log rank P=0.035).

Conclusion

VC assessed by simple and inexpensive radiological method was an independent predictor of novel non-fatal cardiovascular events in HD patients.

Nous rapportons le cas d’une rémission virale soutenue, avec l’association de sofosbuvir 400 mg administré après chaque séance d’hémodialyse et daclatasvir 60 mg par jour, pendant 3 mois, chez un patient infecté par le virus de l’hépatite C (VHC) génotype 1, transplanté hépatique et traité par hémodialyse. Peu d’effets secondaires sont survenus au cours du traitement. Les paramètres biologiques sont restés stables et aucune interaction médicamenteuse n’a été notée. Ce schéma, s’il est validé par d’autres études, pourrait contribuer à améliorer la morbi-mortalité chez les patients hémodialysés infectés par le VHC.

We report a case of sustained remission of a liver transplant patient infected with hepatitis C virus (HCV) genotype 1 undergoing hemodialysis treatment. Oral treatment regimen of the HCV infection consists of a combination of sofosbuvir 400 mg after each hemodialysis session and daclatasvir 60 mg daily, for a period of 3 months. Laboratory testing indicate that the combination regimen was well-tolerated with no sign of drug-drug interaction. Confirmation of these clinical observations in large clinical studies may help improve morbidity and decrease mortality outcome in patients infected with HCV and undergoing hemodialysis treatment.