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Bi Y, Yang Y, Yuan X, Wang J, Liu Z, Tian S, Sun C. Clinical Evidence of the Relationship Between Alanine Aminotransferase and Diabetic Kidney Disease. Diabetes Metab Syndr Obes 2024; 17:261-269. [PMID: 38269337 PMCID: PMC10807274 DOI: 10.2147/dmso.s442165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
Aim Multiple studies have investigated the association between alanine aminotransferase (ALT) and diabetes mellitus (DM); however, only a few studies have specifically examined the relationship between ALT and diabetic kidney disease (DKD). This study aimed to investigate the relationship between ALT and DKD using clinical data. Methods A cross-sectional study was conducted on 668 individuals that included non-DM (N=281), DM without DKD (N=160), and DKD (N=227) patients. A generalized additive model (GAM) was used to examine the dose-response relationship between ALT and DKD risk. We also analyzed the data from the US National Health and Nutrition Examination Survey (NHANES) 2015-2018 using the same statistical methods; 4481, 1110, and 671 individuals were included in the non-DM, DM without DKD, and DKD groups, respectively. Results The changes in ALT activity among the non-DM, DM without DKD, and DKD groups showed a similar pattern in both our clinical data and the NHANES dataset. ALT activity increases with the onset of DM, whereas ALT activity decreases when DM progresses to DKD. The GAM revealed a nonlinear U-shaped relationship between ALT and DKD risk in the two datasets, and the lowest range of ALT was 40-50 IU/L. Both lower (<40 IU/L) and higher (>50 IU/L) ALT activity were found to be positively associated with DKD risk. Conclusion A U-shaped nonlinear association between ALT and DKD was found in our clinical data and NHANES data. DKD risk was increased by both lower or higher ALT activity. To confirm the causality of nonlinear relationship, larger prospective studies or Mendelian randomization analysis are required.
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Affiliation(s)
- Yaru Bi
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
| | - Yang Yang
- Department of Health Examination Center, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
| | - Xiaojie Yuan
- Department of Clinical Nutrition, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
| | - Jiping Wang
- Department of Clinical Nutrition, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
| | - Zhiyuan Liu
- Department of Clinical Medicine, Yanbian University, Yanji, 136200, People’s Republic of China
| | - Suyan Tian
- Division of Clinical Research, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
| | - Chenglin Sun
- Department of Endocrinology and Metabolism, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
- Department of Clinical Nutrition, First Hospital of Jilin University, Changchun, 130000, People’s Republic of China
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Hori M, Yasuda K, Takahashi H, Aoi T, Mori Y, Tsujita M, Shirasawa Y, Kondo C, Hashimoto T, Koyama H, Morozumi K, Maruyama S. The Impact of Liver Chemistries on Respiratory Failure among Hemodialysis Patients with COVID-19 during the Omicron Wave. Intern Med 2023; 62:2617-2625. [PMID: 37407459 PMCID: PMC10569926 DOI: 10.2169/internalmedicine.2115-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Although the coronavirus disease 2019 (COVID-19) Omicron variant causes less severe symptoms than previous variants, early indicators for respiratory failure are needed in hemodialysis patients, who have a higher mortality rate than the general population. Liver chemistries are known to reflect the severity of COVID-19 in the general population. This study explored the early indicators for worsened respiratory failure based on patient characteristics, including liver chemistries. Methods This retrospective study included 117 patients admitted for COVID-19 during the Omicron wave. Respiratory failure was defined as oxygen requirement during treatment. Information on the symptoms and clinical characteristics, including liver chemistries [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)], at admission was collected. Results Thirty-five patients (29.9%) required oxygen supply during treatment. In the multivariate logistic regression analyses, AST [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.00-1.13, p=0.029], ALT (OR 1.09, 95% CI 1.02-1.18, p=0.009), and moderate COVID-19 illness (Model including AST, OR 6.95, 95% CI 2.23-23.17, p<0.001; Model including ALT, OR 7.19, 95% CI 2.21-25.22, p=0.001) were independent predictors for respiratory failure. Based on the cutoff values determined by the receiver operating characteristic curve, higher AST (≥23 IU/L) and ALT levels (≥14 IU/L) were also independently associated with respiratory failure (higher AST: 64.3% vs. 18.8%, OR 3.44, 95% CI 1.08-11.10, p=0.035; higher ALT: 48.8% vs. 19.7%, OR 4.23, 95% CI 1.34-14.52, p=0.013, respectively). Conclusion The measurement of AST and ALT levels at baseline may help predict oxygen requirement in hemodialysis patients with COVID-19.
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Affiliation(s)
- Mayuko Hori
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Kaoru Yasuda
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Hiroshi Takahashi
- Department of Nephrology, Fujita Health University School of Medicine, Japan
| | - Tomonori Aoi
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Yoshiko Mori
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Makoto Tsujita
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | | | - Chika Kondo
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Takashi Hashimoto
- Department of General Internal Medicine, Masuko Memorial Hospital, Japan
| | - Hiroichi Koyama
- Department of General Internal Medicine, Masuko Memorial Hospital, Japan
| | - Kunio Morozumi
- Department of Nephrology, Masuko Memorial Hospital, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Japan
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The Impact of Antiviral Treatment of Hepatitis B Virus after Kidney Transplant and the Latest Insights. Pathogens 2023; 12:pathogens12020340. [PMID: 36839612 PMCID: PMC9962423 DOI: 10.3390/pathogens12020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The current frequency of hepatitis B virus infection in patients with advanced chronic kidney disease (CKD) (including patients on maintenance dialysis and kidney transplant recipients) is low but not negligible worldwide. HBV has a deleterious effect on survival after a kidney transplant; antiviral treatments improved the short-term outcomes of kidney transplant recipients, but their long-term impact remains uncertain. AIM The aim of this review is to assess the role of antiviral therapy for HBV in improving survival after a kidney transplant. The recent publication of large surveys has prompted us to update the available evidence on the impact of HBV on patient and graft survival after a kidney transplant. METHODS We have conducted an extensive review of the medical literature, and various research engines have been used. RESULTS We retrieved several studies (n = 11; n = 121,436 unique patients) and found an association between positive serologic HBsAg status and diminished patient and graft survival after a kidney transplant; the adjusted relative risk (aRR) of all-cause mortality and graft loss was 2.85 (95% CI, 2.36; 3.33, p < 0.0001) and 1.26 (95% CI, 1.02; 1.51, p < 0.0001), respectively. To our knowledge, at least six studies reported improved patient and graft survival after the adoption of antiviral therapies for HBV (this result was reported with both survival curves and multivariable regression). According to novel clinical guidelines, entecavir has been suggested as a 'first line' antiviral agent for the treatment of HBV after a kidney transplant. CONCLUSIONS The recent availability of safe and effective antiviral drugs for the treatment of HBV has meant that the survival curves of HBsAg-positive patients on antiviral therapy and HBsAg-negative patients after a kidney transplant can be comparable. Antiviral therapy should be systematically proposed to HBV-positive kidney transplant recipients and candidates to avoid the deleterious hepatic and extra-hepatic effects of chronic HBV replication.
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4
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Wu Y, Liu F. Aspartate aminotransferase to alanine aminotransferase ratio and the risk of diabetic nephropathy progression in patients with type 2 diabetes mellitus: A biopsy-based study. J Diabetes Complications 2022; 36:108235. [PMID: 35853763 DOI: 10.1016/j.jdiacomp.2022.108235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To study the relationship between baseline serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) in both clinicopathological features and renal outcome among type 2 diabetes mellitus (T2DM) patients with biopsy-confirmed diabetic nephropathy (DN). METHODS As a retrospective cohort study, we included 253 patients with T2DM and biopsy-confirmed DN. For receiver operating characteristic (ROC) curve showed that the optimal cut-off for AAR to predict end stage renal disease (ESRD) was 1.22. So, patients were divided into two groups according to their AAR at the time of renal biopsy: high AAR Group (those with AAR > 1.22); low AAR Group (those with AAR ≤1.22). Association between AAR and clinicopathological features as well as renal outcome were analyzed. RESULTS Patients with higher AAR presented elder, more hypertensive, more insulin use, higher serum cholesterol, more proteinuria and lower estimated glomerular filtration rate (eGFR). Compared with low AAR group, patients with high AAR had more severe glomerular pathological lesions and interstitial fibrosis and tubular atrophy. For prognostic analysis, high AAR Group was associated with a higher risk of progression to ESRD in univariate analysis. No matter treated with continuous or categorical variate, higher AAR remained an independent predictor for ESRD after adjusted for various confounding factors: gender, age, the duration of diabetes, serum glucose level, hypertension, serum lipid level, smoking, insulin use, eGFR and proteinuria. CONCLUSION High AAR was associated with more severe renal pathologic lesions and worse renal function in patients with T2DM and DN, which might be a novel noninvasive predictor for ESRD. CLINICAL RELEVANCE To our knowledge, there was no biopsy-based cohort study. In our study, high AAR was associated with more severe renal pathologic lesions and worse renal function in patients with T2DM and DN, which might be a novel noninvasive predictor of ESRD for patients with DN.
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Affiliation(s)
- Yucheng Wu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, Sichuan, China; Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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5
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Park S, Lee S, Kim Y, Cho S, Huh H, Kim K, Kim YC, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Mendelian randomization reveals causal effects of kidney function on various biochemical parameters. Commun Biol 2022; 5:713. [PMID: 35856088 PMCID: PMC9293908 DOI: 10.1038/s42003-022-03659-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
The kidney is a vital organ with diverse biological effects and the burden of kidney function impairment is increasing in modern medicine. As the effects from kidney function on diverse biochemical parameters are yet fully understood, additional investigation to reveal the causal effects is warranted. Here we show the causal estimates from kidney function parameter, estimated glomerular filtration rate (eGFR), on 60 biochemical parameters by performing two-sample Mendelian randomization (MR) study in 337,138 white British UK Biobank participants. A higher genetically predicted eGFR was significantly associated with higher lymphocyte percentage, HDL cholesterol, and alanine aminotransferase. The causal estimates indicated that a higher genetically predicted eGFR was associated with lower urea, urate, insulin growth factor-1, and triglycerides levels. The parameters with significant but non-linear causal estimates were hemoglobin concentration, calcium, vitamin D, and urine creatinine values, identified by non-linear MR. Healthcare providers should understand that changes in eGFR may affect the identified biochemical parameters in diverse patterns. Future study is warranted to expand the knowledge of the mechanisms and clinical implications of the causal effects of eGFR on various biochemical parameters.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea
| | - Soojin Lee
- Department of Internal Medicine, Uijeongbu Eulji University Medical Center, Gyeonggi-do, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Semin Cho
- Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gyeonggi-do, Korea
| | - Hyeok Huh
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Seok Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yon Su Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Kidney Research Institute, Seoul National University, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. .,Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. .,Kidney Research Institute, Seoul National University, Seoul, Korea.
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6
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Fareed SA, Almilaibary AA, Nooh HZ, Hassan SM. Ameliorating effect of gum arabic on the liver tissues of the uremic rats; A biochemical and histological study. Tissue Cell 2022; 76:101799. [DOI: 10.1016/j.tice.2022.101799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 11/26/2022]
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7
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Selen T, Akoglu H, Agbaht K. Relationship between liver function tests & cardiovascular risk factors in stage 3-5 pre-dialysis chronic kidney disease. Indian J Med Res 2022; 155:397-402. [DOI: 10.4103/ijmr.ijmr_1777_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Aminotransferase-to-platelet ratio index and Fibrosis-4 index score predict hepatic fibrosis evaluated by transient hepatic elastography in hepatitis C virus-infected hemodialysis patients. Eur J Gastroenterol Hepatol 2021; 33:e260-e265. [PMID: 33405422 DOI: 10.1097/meg.0000000000002031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE This study aimed to evaluate the performance of aminotransferase-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) in chronic kidney disease stage 5D HCV-infected patients compared to transient hepatic elastography (TE) as the gold standard. METHODS Hemodialysis HCV-infected patients submitted to TE (FibroScan, Echosens, Paris, France) had APRI and FIB-4 calculated. Based on the best area under receiver operating characteristic curve (AUROC) for significant fibrosis and cirrhosis, APRI and FIB-4 cutoffs were determined and their performances were compared. RESULTS Seventy patients were included. Both APRI and FIB-4 showed good performance for identifying significant fibrosis [AUROC = 0.73, 95% confidence interval (CI) 0.61-0.83 and 0.79, 95% CI 0.68-0.88; P < 0.05] and cirrhosis [AUROC = 0.82, 95% CI 0.71-0.90 and 0.85, 95% CI 0.75-0.93; P < 0.05]. APRI ≤ 0.25 excluded significant fibrosis with negative predictive value (NPV) of 81.8% and APRI > 0.61 confirmed it with a positive predictive value (PPV) of 81.8%. Similarly, NPV for FIB-4 ≤ 0.60 regarding significant fibrosis was 90.9%. NPV for cirrhosis for APRI ≤ 0.42 or FIB-4 ≤ 1.40 was 97%. However, APRI > 0.73 or FIB-4 > 2.22 showed a modest PPV of 60 and 70% to confirm cirrhosis, respectively. CONCLUSION APRI and FIB-4 are simple, non-expensive scoring systems with good accuracy to assess fibrosis in HCV-infected hemodialysis patients, mainly excluding both significant fibrosis or cirrhosis and may be an alternative to TE in the evaluation of this population.
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Griffin TP, O'Shea PM, Smyth A, Islam MN, Wall D, Ferguson J, O'Sullivan E, Finucane FM, Dinneen SF, Dunne FP, Lappin DW, Reddan DN, Bell M, O'Brien T, Griffin DG, Griffin MD. Burden of chronic kidney disease and rapid decline in renal function among adults attending a hospital-based diabetes center in Northern Europe. BMJ Open Diabetes Res Care 2021; 9:9/1/e002125. [PMID: 37077135 PMCID: PMC8204173 DOI: 10.1136/bmjdrc-2021-002125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/09/2021] [Indexed: 12/30/2022] Open
Abstract
IntroductionThis study aimed to determine the prevalence of diabetic kidney disease (DKD) and rapid renal function decline and to identify indices associated with this decline among adults attending a diabetes center in Northern Europe.Research design and methodsThis is a retrospective cohort study of 4606 patients who attended a diabetes center in Ireland between June 2012 and December 2016. Definition/staging of chronic kidney disease used the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 classification based on data from the most recently attended appointment. Relevant longitudinal trends and variabilities were derived from serial records prior to index visit. Rapid renal function decline was defined based on per cent and absolute rates of estimated glomerular filtration rate (eGFR) change. Multiple linear regression was used to explore the relationships between explanatory variables and per cent eGFR change.Results42.0% (total), 23.4% (type 1 diabetes), 47.9% (type 2 diabetes) and 32.6% (other diabetes) had DKD. Rapid decline based on per cent change was more frequent in type 2 than in type 1 diabetes (32.8% vs 14.0%, p<0.001). Indices independently associated with rapid eGFR decline included older age, greater number of antihypertensives, higher log-normalized urine albumin to creatinine ratio (LNuACR), serum alkaline phosphatase, thyroid stimulating hormone, variability in systolic blood pressure and variability in LNuACR, lower glycated hemoglobin, high-density lipoprotein cholesterol and diastolic blood pressure, and lack of ACE inhibitor/angiotensin receptor blocker prescription.ConclusionsDKD (using the KDIGO 2012 classification) and rapid eGFR decline were highly prevalent among adults attending a hospital-based diabetes clinic in a predominantly Caucasian Northern European country. The burden was greater for adults with type 2 diabetes. Expected as well as potentially novel clinical predictors were identified.
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Affiliation(s)
- Tomás P Griffin
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paula M O'Shea
- Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Andrew Smyth
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
- Health Research Board (HRB), Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
- Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Md Nahidul Islam
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Deirdre Wall
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Galway, Ireland
| | - John Ferguson
- Health Research Board (HRB), Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
| | - Esther O'Sullivan
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Francis M Finucane
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Sean F Dinneen
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Fidelma P Dunne
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - David W Lappin
- Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Donal N Reddan
- Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Marcia Bell
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Timothy O'Brien
- Centre for Endocrinology, Diabetes and Metabolism, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Damian G Griffin
- Department of Clinical Biochemistry, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
| | - Matthew D Griffin
- Regenerative Medicine Institute (REMEDI) at CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Nephrology, Saolta University Health Care Group, Galway University Hospitals, Galway, Ireland
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Cedeño Y, Miranda M, Orjales I, Herrero-Latorre C, Suárez M, Luna D, López-Alonso M. Trace Element Levels in Serum Are Potentially Valuable Diagnostic Markers in Dogs. Animals (Basel) 2020; 10:E2316. [PMID: 33297385 PMCID: PMC7762272 DOI: 10.3390/ani10122316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 01/04/2023] Open
Abstract
The objective of this study was to obtain information about the role of trace element imbalance in the pathogenesis of certain diseases in dogs and to evaluate the suitability of trace element profiling as an additional tool in the diagnosis. Serum trace element concentrations (copper, molybdenum, selenium and zinc) were measured in a cohort of healthy (control) dogs (n = 42) and dogs affected by hepatic (n = 25), gastrointestinal (n = 24), inflammatory/infection (n = 24), and renal (n = 22) diseases. These data were analyzed together with data on basic biochemical parameters (alanine aminotransferase, alkaline phosphatase, blood urea nitrogen, creatinine, albumin, globulin, and glucose) by using chemometric techniques. The chemometric analysis revealed distinctive association patterns between trace elements and biochemical parameters for each clinical disorders. The findings provide clear evidence for the important role of trace elements in disease, particularly in relation to acute phase reactions, with serum copper providing an indirect measurement of ceruloplasmin (positive acute-phase protein) and serum selenium and zinc acting as negative acute phase reactants. Molybdenum may also be a suitable marker of incipient renal disease. Thus, the analysis of trace element profiles, by multielement techniques, in a single serum sample would be a valuable additional tool for the diagnosis of certain diseases.
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Affiliation(s)
- Yolanda Cedeño
- Department of Animal Pathology, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain; (Y.C.); (D.L.); (M.L.-A.)
- Faculty of Veterinary Medicine, Universidad Central del Ecuador, EC170521 Quito, Ecuador
| | - Marta Miranda
- Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain; (I.O.); (M.S.)
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain
| | - Inmaculada Orjales
- Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain; (I.O.); (M.S.)
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain
| | - Carlos Herrero-Latorre
- Research Institute on Chemical and Biological Analysis, Analytical Chemistry, Nutrition and Bromatology Department, Faculty of Sciences, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain;
| | - Maruska Suárez
- Department of Anatomy, Animal Production and Clinical Veterinary Sciences, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain; (I.O.); (M.S.)
- Rof-Codina Veterinary Teaching Hospital, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain
| | - Diego Luna
- Department of Animal Pathology, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain; (Y.C.); (D.L.); (M.L.-A.)
- Faculty of Veterinary Medicine, Universidad Central del Ecuador, EC170521 Quito, Ecuador
| | - Marta López-Alonso
- Department of Animal Pathology, Faculty of Veterinary, Campus Terra, Universidade de Santiago de Compostela, 27002 Lugo, Spain; (Y.C.); (D.L.); (M.L.-A.)
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11
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Evaluation of Liver Enzymes in End-Stage Renal Disease Patients on the Renal Transplant-Waiting List in North-West of Iran. Nephrourol Mon 2020. [DOI: 10.5812/numonthly.107859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Liver diseases, mainly hepatitis B and C, commonly occur in patients with end-stage renal diseases (ESRD). Alanine and aspartate aminotransferase are important for the diagnosis and monitoring of liver diseases. Several studies demonstrated that patients with chronic kidney disease (CKD) have lower levels of serum aminotransferases than the normal population. The present study was designed to compare these enzymes in different types of dialysis in ESRD patients and the general population in Iran. Methods: In this cross-sectional study, ESRD patients who were candidates for organ transplants in Montaserieh Hospital in Mashhad (Iran) from 2007 to 2014 were enrolled. The data of 1116 patients were collected by reviewing their medical records. Patients were divided into two groups of hemodialysis (n = 1034) and peritoneal dialysis (n = 82); their liver enzymes were compared with 510 healthy individuals from the MASHAD study. Results: There was a significant difference between hemodialysis and peritoneal dialysis patients and the control group regarding the age (P < 0.0001) and gender (P = 0.005). Conclusions: The reduction in serum aminotransferase levels in ESRD cases compared to the control group suggested that renal failure influences liver enzymes that were mildly increased in peritoneal dialysis versus hemodialysis patients in samples provided before the dialysis session.
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12
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Potential protective effect of leptin and uncoupling protein-2 genes polymorphism in Egyptian patients with chronic kidney disease. Int Urol Nephrol 2020; 52:2153-2160. [PMID: 32720029 DOI: 10.1007/s11255-020-02567-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Kidney disease is a serious public health problem worldwide. It is the fifth top-ranking cause of death in Egypt, causing approximately 3.98% of all deaths. This study's objective was to examine whether an association exists between leptin (- 2548G/A) and uncoupling protein-2 45 bp I/D genes, individually and collectively, in CKD and progression to ESRD. METHODS One hundred patients (69 males, 31 females) aged (47.1 ± 16.11 years) with ESRD, 40 patients (19 males, 21 females) aged (43.15 ± 10.00 years with CKD, and 50 healthy controls (23 males, 27 females) aged (37.84 ± 1.95 years) were enrolled. Polymerase chain reaction (PCR) was employed to measure variation in gene expression among the study groups. The frequency of single nucleotide polymorphisms (SNP) genotypes were identified in controls, CKD and ESRD patients. RESULTS Leptin genotypes were associated with lower CKD incidence in control versus study subjects (95% CI = (0.08-0.63), P = 0.01) with risk value equal to 0.22 < 1, G/A genotype was significantly lower in CKD than ESRD groups. There was no correlation between UCP-2 I/D genotype and CKD (P = 0.27). There was no correlation between the UCP-2 gene and the progression to ESRD. CONCLUSIONS This study suggests that, Leptin - 2548G/A gene may be a promising marker for early detection of ESRD in Egyptian patients. G/A genotype might inhibit the development of CKD to ESRD.
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13
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Constancio NS, Ferraz MLG, Martins CTB, Kraychete AC, Bitencourt PL, Nascimento MMD. Hepatitis C in Hemodialysis Units: diagnosis and therapeutic approach. ACTA ACUST UNITED AC 2020; 41:539-549. [PMID: 30806444 PMCID: PMC6979573 DOI: 10.1590/2175-8239-jbn-2018-0177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/28/2018] [Indexed: 12/13/2022]
Abstract
According to data from the last census of the Brazilian Society of Nephrology (SBN), the prevalence of hepatitis C virus (HCV) in Brazilian hemodialysis units (HU) is 3.3%, about three times higher than what is reported for the Brazilian general population. Often, professionals working in HU are faced with clinical situations that require rapid HCV diagnosis in order to avoid horizontal transmission within the units. On the other hand, thanks to the development of new antiviral drugs, the cure of patients with HCV, both in the general population and in patients with chronic kidney disease and the disease eradication, appear to be very feasible objectives to be achieved in the near future . In this scenario, SBN and the Brazilian Society of Hepatology present in this review article a proposal to approach HCV within HUs.
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Affiliation(s)
- Natasha Silva Constancio
- Associação Renal Vida Rio do Sul, Rio do Sul, SC, Brasil.,Sociedade Brasileira de Nefrologia, São Paulo, SP, Brasil
| | - Maria Lucia Gomes Ferraz
- Universidade Federal de São Paulo, São Paulo, SP, Brasil.,Sociedade Brasileira de Hepatologia, São Paulo, SP, Brasil
| | | | | | | | - Marcelo Mazza do Nascimento
- Universidade Federal do Paraná, Curitiba, PR, Brasil.,Sociedade Brasileira de Nefrologia, São Paulo, SP, Brasil
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14
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Fernando BNTW, Sudeshika TSH, Hettiarachchi TW, Badurdeen Z, Abeysekara TDJ, Abeysundara HTK, Jayasinghe S, Ranasighe S, Nanayakkara N. Evaluation of biochemical profile of Chronic Kidney Disease of uncertain etiology in Sri Lanka. PLoS One 2020; 15:e0232522. [PMID: 32365131 PMCID: PMC7197770 DOI: 10.1371/journal.pone.0232522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/16/2020] [Indexed: 01/04/2023] Open
Abstract
Chronic Kidney Disease of uncertain etiology (CKDu) is an endemic, disease that mostly affects young agricultural workers in the rural dry zone of Sri Lanka. This study was designed to identify specific biochemical manifestations of CKDu cases. All (119) non-dialysis definite CKDu patients in Girandurukotte and Wilgamuwa were selected. Blood and urine samples were collected and measured biochemical parameters. All analyses were performed in IBM SPSS statistics version 23 (IBM Corp, USA). The median blood pressure was normal though nearly half of the patients (45.4%) who were in the advanced stages (Stage 3b, 4 and 5) of CKDu. Patients without a history of hypertension before the diagnosis of CKDu (100%) and minimal proteinuria (26%) are similar to the previous findings. Patients without a history of diabetes before the CKDu diagnosis had high percentages of diabetes (15.7%) and pre-diabetes (59.8%) and hence indicated the possibility of uremia induced impaired glucose intolerance in the rural areas of the country. There were 62.2% patients who had low vitamin D and only a minority had evidence of bone mineral diseases. Out of liver disease markers serum glutamic pyruvic transaminases (SGPT), serum glutamic oxaloacetic transaminases (SGOT), gamma-glutamyl transferase (GGT), and Lactic acid degydrogenase (LDH) had an inverse correlation with the advancement of the disease indicating subclinical liver disease. Osmolality in serum and urine showed a discrepancy despite > 50% of CKDu patients had increased their serum osmolality. The current study supports most of the previously described manifestations of CKDu. Moreover, some specific patterns have been identified which need to be validated in a larger group.
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Affiliation(s)
- Buddhi N. T. W. Fernando
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka
- * E-mail:
| | - Thilini S. H. Sudeshika
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilini W. Hettiarachchi
- Faculty of Medicine, Centre for Education, Research and Training on Kidney Diseases (CERTKiD), University of Peradeniya, Peradeniya, Sri Lanka
| | - Zeid Badurdeen
- Faculty of Medicine, Centre for Education, Research and Training on Kidney Diseases (CERTKiD), University of Peradeniya, Peradeniya, Sri Lanka
| | - Thilak D. J. Abeysekara
- Faculty of Medicine, Centre for Education, Research and Training on Kidney Diseases (CERTKiD), University of Peradeniya, Peradeniya, Sri Lanka
| | - Hemalika T. K. Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sakunthala Jayasinghe
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Shirani Ranasighe
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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15
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Lim AKH. Abnormal liver function tests associated with severe rhabdomyolysis. World J Gastroenterol 2020; 26:1020-1028. [PMID: 32205993 PMCID: PMC7081005 DOI: 10.3748/wjg.v26.i10.1020] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/06/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023] Open
Abstract
Rhabdomyolysis is a syndrome of skeletal muscle injury with release of cellular constituents such as potassium, phosphate, urate and intracellular proteins such as myoglobin into the circulation, which may cause complications including acute kidney injury, electrolyte disturbance and cardiac instability. Abnormal liver function tests are frequently observed in cases of severe rhabdomyolysis. Typically, there is an increase in serum aminotransferases, namely aspartate aminotransferase and alanine aminotransferase. This raises the question of liver injury and often triggers a pathway of investigation which may lead to a liver biopsy. However, muscle can also be a source of the increased aminotransferase activity. This review discusses the dilemma of finding abnormal liver function tests in the setting of muscle injury and the potential implications of such an association. It delves into some of the clinical and experimental evidence for correlating muscle injury to raised aminotransferases, and discusses pathophysiological mechanisms such as oxidative stress which may cause actual liver injury. Serum aminotransferases lack tissue specificity to allow clinicians to distinguish primary liver injury from muscle injury. This review also explores potential approaches to improve the accuracy of our diagnostic tools, so that excessive or unnecessary liver investigations can be avoided.
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Affiliation(s)
- Andy KH Lim
- Department of General Medicine, Monash Health, Clayton VIC 3168, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton VIC 3168, Australia
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16
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Lim AKH, Arumugananthan C, Lau Hing Yim C, Jellie LJ, Wong EWW, Junckerstorff RK. A Cross-Sectional Study of the Relationship between Serum Creatine Kinase and Liver Biochemistry in Patients with Rhabdomyolysis. J Clin Med 2019; 9:jcm9010081. [PMID: 31905634 PMCID: PMC7019809 DOI: 10.3390/jcm9010081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 12/20/2022] Open
Abstract
Abnormal liver function tests are commonly observed with rhabdomyolysis, but the nature of this association is not fully defined. This study aims to determine the functional relationship between serum creatine kinase, as a marker of rhabdomyolysis severity, and liver biochemistry. We used linear regression to model the relationship between liver biochemistry and peak serum creatine kinase. A total of 528 patients with a median age of 74 years were included. The distribution of creatine kinase, bilirubin, alkaline phosphatase, alanine aminotransferase, and γ-glutamyl transferase were significantly skewed, and these variables were log-transformed prior to regression. There was a positive linear correlation between log-alanine aminotransferase and log-creatine kinase. In the multiple regression analysis, log-creatine kinase, age, acute kidney injury stage, and chronic liver disease were independently associated with log-alanine aminotransferase. This model explained 46% of the variance of log-alanine aminotransferase. We found no correlation between the log-creatine kinase and the log-bilirubin, log-alkaline phosphatase, or log-γ-glutamyl transferase. Serum alanine aminotransferase was not associated with inpatient mortality but a higher creatine kinase-alanine aminotransferase ratio was associated with lower odds of mortality. In conclusion, an isolated elevation in alanine aminotransferase can occur in rhabdomyolysis, and it may be possible to anticipate the level of increase based on the peak creatine kinase.
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Affiliation(s)
- Andy K. H. Lim
- General Medicine, Monash Health, Clayton, Victoria 3168, Australia; (C.A.); (C.L.H.Y.); (L.J.J.); (E.W.W.W.); (R.K.J.)
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
- Correspondence:
| | - Chitherangee Arumugananthan
- General Medicine, Monash Health, Clayton, Victoria 3168, Australia; (C.A.); (C.L.H.Y.); (L.J.J.); (E.W.W.W.); (R.K.J.)
| | - Corinne Lau Hing Yim
- General Medicine, Monash Health, Clayton, Victoria 3168, Australia; (C.A.); (C.L.H.Y.); (L.J.J.); (E.W.W.W.); (R.K.J.)
| | - Lucy J. Jellie
- General Medicine, Monash Health, Clayton, Victoria 3168, Australia; (C.A.); (C.L.H.Y.); (L.J.J.); (E.W.W.W.); (R.K.J.)
| | - Elena W. W. Wong
- General Medicine, Monash Health, Clayton, Victoria 3168, Australia; (C.A.); (C.L.H.Y.); (L.J.J.); (E.W.W.W.); (R.K.J.)
| | - Ralph K. Junckerstorff
- General Medicine, Monash Health, Clayton, Victoria 3168, Australia; (C.A.); (C.L.H.Y.); (L.J.J.); (E.W.W.W.); (R.K.J.)
- Department of Medicine, Monash University, Clayton, Victoria 3168, Australia
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17
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Ikeda T, Ishihara H, Takagi T, Fukuda H, Yoshida K, Iizuka J, Kobayashi H, Okumi M, Ishida H, Kondo T, Tanabe K. The De Ritis (Aspartate Transaminase/Alanine Transaminase) Ratio as a Prognosticator in Patients With End-stage Renal Disease-associated Renal Cell Carcinoma. Clin Genitourin Cancer 2019; 18:236-240.e1. [PMID: 31917171 DOI: 10.1016/j.clgc.2019.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aspartate transaminase (AST)/alanine transaminase (ALT) ratio (ie, the De Ritis ratio) is associated with prognosis in some types of cancers including renal cell carcinoma (RCC). Meanwhile, an effective prognosticator for end-stage renal disease (ESRD)-associated RCC remains unknown. Thus, we investigated the prognostic impact of the AST/ALT ratio in patients with ESRD-associated RCC. PATIENTS AND METHODS We retrospectively evaluated 243 patients receiving radical nephrectomy for nonmetastatic ESRD-associated RCC. The patients were divided according to the cutoff value of preoperative AST/ALT ratio. Prognostic factors associated with cancer-specific survival (CSS) after radical nephrectomy were analyzed. RESULTS The maximum Youden index showed that the cutoff value of the AST/ALT ratio was 1.42. The high AST/ALT ratio group (≥ 1.42; n = 88) had a significantly shorter 10-year CSS than the low AST/ALT ratio group (64.3% vs. 87.2%; P = .0027). Multivariate analysis revealed that the AST/ALT ratio was an independent prognostic factor of CSS (hazard ratio [HR], 3.03; P = .0020), together with serum C-reactive protein level (HR, 4.84; P < .0001), pathologic stage (HR, 2.79; P = .0030), and tumor grade (HR, 7.08; P = .0087). Based on these independent factors, the patients were further classified into 3 groups: low (0-1 factor), intermediate (2 factors), and high risk (3-4 factors). The 10-year CSS in the high-risk group was significantly shorter than that of the other groups (68.9% vs. 70.9% vs. 94.4%; P < .0001). CONCLUSION The AST/ALT ratio can aid in the risk classification of patients with ESRD-associated RCC.
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Affiliation(s)
- Takashi Ikeda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Toshio Takagi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Yoshida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Junpei Iizuka
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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18
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Zubkin ML, Shchepetkova GS, Balkarova OV, Chervinko VI, Kryukov EV. Successful Hepatitis C Virus Eradication in a Hemodialysis Patient With 2k/1b Chimera Genotype: A Case Report and Literature Review. Gastroenterology Res 2019; 12:176-180. [PMID: 31236161 PMCID: PMC6575136 DOI: 10.14740/gr1171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/05/2019] [Indexed: 01/04/2023] Open
Abstract
Treatment of hemodialysis patients infected with two or three hepatitis C virus (HCV) genotypes (Gt) with interferon-free regimens has not been possible until the recent introduction of pan-genotypic next generation therapy. The main reason is that sofosbuvir (SOF)-containing regimens are contraindicated in patients with low glomerular filtration rate. We describe here a case of a chronic HCV infection in a patient with end-stage renal disease, successfully treated with gleсaprevir/pibrentasvir (GLE/PIB). Limited published data are available regarding the efficacy of antiviral therapy in patients with rare HCV recombinant Gt 2k/1b. We were not able to identify any reports describing treatment of hemodialysis patients with this recombinant type of HCV. We present a 57-year-old patient with autosomal-dominant polycystic kidney disease with liver involvement with end-stage of kidney disease. He was infected with HCV Gt 2k/1b variant after initiation of hemodialysis. This subtype appeared in Russia (Soviet Union that times) as a result of high frequency of virus mutations, and actually is widely spread in some states of the post-Soviet space, as well as in the countries with intensive migration from Russia and other former Soviet republics. In this particular case, we observed a tendency to a rapid progression of liver fibrosis despite mild clinical activity of chronic hepatitis C. A 12-week course of GLE/PIB allowed achieving sustained virologic response (SVR) and was well tolerated.
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Affiliation(s)
- Mikhail Leonidovich Zubkin
- Сlinical and Diagnostic Department, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, 125212 Moscow, Russia
| | - Galina Sergeevna Shchepetkova
- Сlinical and Diagnostic Department, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, 125212 Moscow, Russia
| | | | - Valeriy Ivanovich Chervinko
- Сlinical and Diagnostic Department, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, 125212 Moscow, Russia
| | - Evgeniy Vladimirovich Kryukov
- Сlinical and Diagnostic Department, G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, 125212 Moscow, Russia
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19
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Fabrizi F, Messa P. The epidemiology of HCV infection in patients with advanced CKD/ESRD: A global perspective. Semin Dial 2018; 32:93-98. [PMID: 30536715 DOI: 10.1111/sdi.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver disease in patients with chronic kidney disease (CKD) is most commonly due to hepatitis C virus (HCV) and contributes to increased rates of mortality. Among the pre-dialysis population, the estimated prevalence of anti-HCV positivity is based on few, limited-size studies. In hemodialysis patients however, HCV remains very prevalent despite large declines in seropositivity rates in dialysis facilities in developed countries after preventive measures were adopted in the 1990s. Recent surveys indicate that the HCV seropositivity prevalence ranges from 1.4%-28.3%, and 4.7%-41.9%, among maintenance dialysis patients in developed and developing countries respectively. Although the full extent of dialysis unit-associated HCV transmission is unknown, outbreaks continue to occur, regardless of health system infrastucture. According to US Centers for Disease Control data, over 50% of health care-associated HCVoutbreaks reported from 2008 to 2015 occurred within dialysis facilities. Strict adherence to infection control procedures and routine serologic screening plays a pivotal role in preventing transmission of HCV within hemodialysis units, even in the setting of low HCV prevalence. With the advent of directly acting antivirals, cure of HCV-infected patients on maintenance hemodialysis will help reduce transmission within units and further lower the frequency of HCV infection.
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Affiliation(s)
- Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Piergiorgio Messa
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy.,University School of Medicine, Milan, Italy
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20
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Minutolo R, Aghemo A, Chirianni A, Fabrizi F, Gesualdo L, Giannini EG, Maggi P, Montinaro V, Paoletti E, Persico M, Perticone F, Petta S, Puoti M, Raimondo G, Rendina M, Zignego AL. Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). Intern Emerg Med 2018; 13:1139-1166. [PMID: 30255464 DOI: 10.1007/s11739-018-1940-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/14/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
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Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy.
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases Azienda Ospedaliera Ospedali dei Colli, Naples, Italy
| | - Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Vincenzo Montinaro
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giovanni Raimondo
- Department of Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Hepatology Center MaSVE, University of Florence, Florence, Italy
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21
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Minutolo R, Aghemo A, Chirianni A, Fabrizi F, Gesualdo L, Giannini EG, Maggi P, Montinaro V, Paoletti E, Persico M, Perticone F, Petta S, Puoti M, Raimondo G, Rendina M, Zignego AL. Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). Dig Liver Dis 2018; 50:1133-1152. [PMID: 30266305 DOI: 10.1016/j.dld.2018.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
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Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dvecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138 Naples, Italy.
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases Azienda Ospedaliera Ospedali dei Colli, Naples, Italy
| | - Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Vincenzo Montinaro
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giovanni Raimondo
- Department of Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Hepatology Center MaSVE, University of Florence, Florence, Italy
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22
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Minutolo R, Aghemo A, Chirianni A, Fabrizi F, Gesualdo L, Giannini EG, Maggi P, Montinaro V, Paoletti E, Persico M, Perticone F, Petta S, Puoti M, Raimondo G, Rendina M, Zignego AL. Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). Infection 2018; 47:141-168. [PMID: 30255389 DOI: 10.1007/s15010-018-1209-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
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Affiliation(s)
- Roberto Minutolo
- Division of Nephrology, Department of Scienze Mediche, Chirurgiche, Neurologiche, Metaboliche e dell'Invecchiamento, University of Campania "Luigi Vanvitelli", Via M. Longo 50, 80138, Naples, Italy.
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center, Milan, Italy
| | - Antonio Chirianni
- Third Department of Infectious Diseases Azienda Ospedaliera Ospedali dei Colli, Naples, Italy
| | - Fabrizio Fabrizi
- Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy
| | - Loreto Gesualdo
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Bari, Italy
| | - Vincenzo Montinaro
- Division of Nephrology, Azienda Ospedaliero-Universitaria Policlinico di Bari, Bari, Italy
| | - Ernesto Paoletti
- Nephrology, Dialysis, and Transplantation, University of Genoa and Policlinico San Martino, Genoa, Italy
| | - Marcello Persico
- Internal Medicine and Hepatology Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia, Catanzaro, Italy
| | - Salvatore Petta
- Gastroenterology and Hepatology Unit, Di.Bi.M.I.S., University of Palermo, Palermo, Italy
| | - Massimo Puoti
- Division of Infectious Diseases, Niguarda Cà Granda Hospital, Milan, Italy
| | - Giovanni Raimondo
- Department of Medicina Clinica e Sperimentale, University of Messina, Messina, Italy
| | - Maria Rendina
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University Hospital, Bari, Italy
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Hepatology Center MaSVE, University of Florence, Florence, Italy
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23
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Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). J Nephrol 2018; 31:685-712. [PMID: 30255440 DOI: 10.1007/s40620-018-0523-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.
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24
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Fujii H, Kimura H, Kurosaki M, Hasebe C, Akahane T, Yagisawa H, Kato K, Yoshida H, Itakura J, Sakita S, Satou T, Okada K, Kusakabe A, Kojima Y, Kondo M, Morita A, Nasu A, Tamada T, Okushin H, Kobashi H, Tsuji K, Joko K, Ogawa C, Uchida Y, Mitsuda A, Sohda T, Ide Y, Izumi N. Efficacy of daclatasvir plus asunaprevir in patients with hepatitis C virus infection undergoing and not undergoing hemodialysis. Hepatol Res 2018; 48:746-756. [PMID: 29480939 DOI: 10.1111/hepr.13070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/01/2018] [Accepted: 02/17/2018] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the virologic responses and clinical course of daclatasvir plus asunaprevir treatment in non-hemodialysis (non-HD) and hemodialysis (HD) patients infected with genotype 1 hepatitis C virus (HCV). METHODS A total of 1113 non-HD patients and 67 HD patients were assessed. To evaluate pretreatment factors contributing to sustained virological response at 12 weeks (SVR12), univariate and multivariate analyses were carried out. To adjust for differences in patient background, propensity score matching was undertaken. RESULTS The overall SVR12 rates were 91.6% in non-HD patients and 95.5% in HD patients. Compared with non-HD patients, HD patients were younger, were more likely to be male, were less likely to have received interferon-based pretreatment, had a lower viral load, and had lower levels of alanine transaminase, hemoglobin, and α-fetoprotein. Multivariate analysis revealed that viral load, α-fetoprotein, L31 substitution negative, and Y93 substitution negative were independent predictive factors for SVR12 in non-HD patients. The proportion of patients with undetectable HCV-RNA during the initial 4 weeks was significantly higher in HD patients than in non-HD patients. The SVR12 rate was clearly higher in HD patients than in non-HD patients, although the difference was not statistically significant. After propensity score matching to adjust for viral load, α-fetoprotein, L31 substitution, and Y93 substitution, these trends disappeared. CONCLUSIONS For treatment of HCV genotype 1 infection, daclatasvir plus asunaprevir is useful not only in non-HD patients but also in HD patients. Viral load, α-fetoprotein levels, L31 substitution, and Y93 substitution influence treatment course and outcome.
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Affiliation(s)
- Hideki Fujii
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Hiroyuki Kimura
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Chitomi Hasebe
- Department of Gastroenterology, Asahikawa Red Cross Hospital, Asahikawa, Japan
| | - Takehiro Akahane
- Department of Gastroenterology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Hitoshi Yagisawa
- Department of Gastroenterology, Japanese Red Cross Akita Hospital, Akita, Japan
| | - Keizo Kato
- Department of Gastroenterology, Narita Red Cross Hospital, Narita, Japan
| | - Hideo Yoshida
- Department of Gastroenterology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Jun Itakura
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
| | - Shinya Sakita
- Department of Gastroenterology, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Takashi Satou
- Department of Gastroenterology, Nasu Red Cross Hospital, Otawara, Tochigi, Japan
| | - Kazuhiko Okada
- Department of Gastroenterology, Toyama Red Cross Hospital, Toyama, Japan
| | - Atsunori Kusakabe
- Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yuji Kojima
- Department of Gastroenterology and Hepatology, Japanese Red Cross Ise Hospital, Ise, Japan
| | - Masahiko Kondo
- Department of Gastroenterology, Otsu Red Cross Hospital, Siga, Japan
| | - Atsuhiro Morita
- Department of Gastroenterology, Kyoto Second Red Cross Hospital Gastroenterology, Kyoto, Japan
| | - Akihiro Nasu
- Department of Gastroenterology and Hepatology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takashi Tamada
- Department of Gastroenterology and Hepatology, Takatsuki Red Cross Hospital, Osaka, Japan
| | - Hiroaki Okushin
- Department of Hepatology, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
| | - Haruhiko Kobashi
- Department of Hepatology, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Keiji Tsuji
- Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | - Kouji Joko
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Ehime
| | - Chikara Ogawa
- Department of Gastroenterology and Hepatology, Takamatsu Red Cross Hospital, Takamatsu, Japan
| | - Yasushi Uchida
- Department of Gastroenterology, Matsue Red Cross Hospital, Matsue, Japan
| | - Akeri Mitsuda
- Department of Gastroenterology, Japanese Red Cross Tottori Hospital, Tottori, Japan
| | - Tetsuro Sohda
- Hepatology Division, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Yasushi Ide
- Department of Gastroenterology, Japanese Red Cross Karatsu Hospital, Karatsu, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Musashino, Japan
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25
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Shen X, Cai J, Gao J, Vaidya A, Liu X, Li W, Chen S, Zhou Y, Li Y, Zhang Y, Zhao J, Hu FB, Wu S, Gao X. Nonalcoholic Fatty Liver Disease and Risk of Diabetes: A Prospective Study in China. Endocr Pract 2018; 24:823-832. [PMID: 29975579 DOI: 10.4158/ep-2018-0098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We aimed to investigate whether liver steatosis severity affects the risk of developing diabetes in a large cohort study. METHODS We prospectively examined the association in 41,650 Chinese adults with negative hepatitis-B surface antigen who were free of alcohol consumption, diabetes, and liver cirrhosis at baseline. Cox proportional models were used to estimate the risk of diabetes after a mean of 3.6 years of follow-up. Nonalcoholic fatty liver disease (NAFLD) was assessed with hepatic ultrasonography. Elevated alanine transaminase (ALT) was defined as ALT concentrations >19 and >30 U/L in females and males, respectively. Diabetes was defined as a fasting glucose 37.0 mmol/L or treatment with hypoglycemic medication. RESULTS Liver steatosis severity was significantly associated with higher risks of developing diabetes (adjusted hazard ratio [HR] for severe vs. without NAFLD = 2.66, 95% confidence interval [CI]: 2.17-3.25, P-trend<.001) and impaired fasting glucose (fasting glucose between 5.6 and 6.9 mmol/L, adjusted HR = 1.36, 95% CI: 1.16-1.59, P-trend<.001), as well as a faster increase rate of fasting glucose concentrations ( P-trend<.001), during 3.6 years of follow-up. Elevated ALT was also associated with incident diabetes (HR = 1.12, 95% CI: 1.02-1.22), adjusting for NAFLD and other covariates. CONCLUSION We observed a dose-response relationship between liver steatosis severity and increased diabetes risk, and ALT may predict incident diabetes independently of NAFLD. ABBREVIATIONS ALT = alanine transaminase; BP = blood pressure; CI = confidence interval; HCV = hepatitis C virus; HR = hazard ratio; IFG = impaired fasting glucose; NAFLD = nonalcoholic fatty liver disease; ULN = upper limit of normal.
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26
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Di Cerbo A, Iannitti T, Guidetti G, Centenaro S, Canello S, Cocco R. A nutraceutical diet based on Lespedeza spp., Vaccinium macrocarpon and Taraxacum officinale improves spontaneous feline chronic kidney disease. Physiol Rep 2018; 6:e13737. [PMID: 29906338 PMCID: PMC6003637 DOI: 10.14814/phy2.13737] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022] Open
Abstract
Chronic kidney disease is characterized by structural and/or functional impairment of one or both kidneys persisting for more than 3 months. In cats, chronic kidney disease can frequently occur in animals aged over 9 years with an incidence of approximately 10%. Thirty-four client-owned, neutered cats, suffering from stage II-III chronic kidney disease and diagnosed according to the International Renal Interest Society guidelines were randomly assigned to receive either a control diet (n = 17) or a nutraceutical diet (ND; n = 17) for 90 days. Both diets were commercialized for management of CKD symptoms. The diets were identical except that the ND contained tablets that consisted of 60-80% hydrolysed proteins, 20-40% minerals and active substances, that are, Lespedeza spp. 0.0588%, Vaccinium macrocarpom 0.0371%, and Taraxacum officinale 0.0231%. No adverse effects were reported during this study. Both diets resulted in an improvement in CKD symptoms. After a 90-day evaluation, creatinine, blood urea nitrogen, total proteins, and aspartate aminotransferase significantly decreased in cats that received the ND. A significant decrease was also observed in urine turbidity score, color score, and total proteins in cats that received the ND. We have found that a ND based on Lespedeza spp., Vaccinium macrocarpon, and Taraxacum officinale improves key indicators of renal failure in cats affected by chronic kidney disease.
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Affiliation(s)
- Alessandro Di Cerbo
- Department of Life SciencesUniversity of Modena and Reggio EmiliaModenaItaly
- Department of Medical, Oral and Biotechnological SciencesDental SchoolUniversity G. d' Annunzio of Chieti‐PescaraChietiItaly
| | | | | | - Sara Centenaro
- Research and Development DepartmentSANYpet S.p.aPaduaItaly
| | - Sergio Canello
- Research and Development DepartmentForza10 USA CorpOrlandoFlorida
| | - Raffaella Cocco
- Department of Pathology and Veterinary ClinicFaculty of Veterinary MedicineUniversity of SassariSassariItaly
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27
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HEPATIC ENZYMES CHANGES IN CHRONIC KIDNEY DISEASE PATIENTS- A NEED FOR MODIFIED REFERENCE VALUES. ACTA ACUST UNITED AC 2018. [DOI: 10.14260/jemds/2018/439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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28
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Fabrizi F, Mangano S, Aucella F, Dixit V, Martin P. Hepatitis C Virus Infection and Diabetes Mellitus in End-Stage Renal Disease: Evidence of a Negative Association. Int J Artif Organs 2018; 29:691-7. [PMID: 16874674 DOI: 10.1177/039139880602900707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epidemiological studies have implicated hepatitis C virus (HCV) infection in the pathogenesis of diabetes mellitus (DM) both in the population as a whole and after solid organ transplantation. Whether this association exists in patients with end-stage renal disease (ESRD) undergoing dialysis is unclear. The aim of this study is to investigate the relationship between HCV and DM in a large group (n = 742) of patients with ESRD from Europe and North America. The presence of diabetes was ascertained by using American Diabetes Association guidelines based on fasting glucose measurement and medication history. Presence of HCV infection was assessed by serum testing for anti-HCV antibodies. The prevalence of anti-HCV antibody positive patients was 15% (112/742); the frequency of DM was higher among anti-HCV positive than -HCV negative patients but the difference did not approach statistical significance, 32% (36/112) vs 29.5% (186/630). The frequency of patients with diabetic nephropathy was not higher in anti-HCV positive than -negative patients; 21.4% (24/112) vs 23.3% (147/630), NS. Logistic regression model showed an independent and significant link between anti-HCV seropositive status and raised GPT (P = 0.032), male gender (P = 0.0462), positive history of prior renal transplant (P = 0.0006), and longer time on dialysis (P = 0.00001). In summary, no link between anti-HCV antibody and DM occurred in this ESRD population; there was no association between rate of anti-HCV antibody and diabetic nephropathy.
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Affiliation(s)
- F Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milan, Italy, and Division of Liver Diseases, Mount Sinai Medical School, New York City, New York, USA.
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29
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Fabrizi F, Marzano A, Messa P, Martin P, Lampertico P. Hepatitis B Virus Infection in the Dialysis Population: Current Perspectives. Int J Artif Organs 2018; 31:386-94. [DOI: 10.1177/039139880803100503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
One of the major advances in the management of patients on regular dialysis has been the control of the spread of hepatitis B virus (HBV) infection in dialysis units. The rate of HBsAg positive patients on regular dialysis in the developed world is currently low, but outbreaks of HBV continue to occur. The diffusion of HBV in dialysis units in developing countries is higher, although available information is not abundant. There are limited data on the natural history of HBV in the dialysis population; they support a detrimental effect of HBV on survival in dialysis patients. The HBV viral load in HbsAg-positive dialysis patients appears low and stable over time and numerous mechanisms have been posited to explain it. Several assays for detecting HBV DNA in serum are available but they should not be used for purposes of routine screening within dialysis units. The epidemiology and clinical significance of occult HBV infection in the dialysis population needs to be addressed adequately - this remains an area of active research. Recent recommendations for the management of HBsAg chronic carriers on maintenance dialysis have been issued. No controlled trials for the treatment of hepatitis B with either interferon or lamivudine in dialysis patients are currently available.
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Affiliation(s)
- F. Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milan - Italy
| | - A. Marzano
- Division of Gastroenterology, San Giovanni Battista Hospital, Turin - Italy
| | - P. Messa
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS, Milan - Italy
| | - P. Martin
- Center for Liver Diseases, University School of Medicine, Miami, Florida - USA
| | - P. Lampertico
- Division of Gastroenterology, University School of Medicine, Milan - Italy
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30
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Dzekova P, Asani A, Selim G, Gelev S, Trajceska L, Amitov V, Selja N, Zabzun M, Mena S, Gaseva M, Sikole A. Long-Term follow up of Sustained Viral Response after Treatment of Hepatitis C with Pegylated Interferon α-2a in Hemodialysis Patients. Int J Artif Organs 2018; 32:180-4. [DOI: 10.1177/039139880903200309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Purpose The aim of this study was to evaluate the persistence of sustained viral response after treatment of hepatitis C with pegylated interferon α-2a in hemodialysis patients. Methods 14 hemodialysis patients with chronic hepatitis C were treated with pegylated interferon α-2a for a period of 48 weeks. Achieved sustained viral response rate was 35.7% (5/14 patients) at week 72, i.e. 24 weeks after the treatment ended. All treated patients were then prospectively followed until week 144. Follow-up viral data, such as HCV antibodies, serum HCV RNA, and HCV RNA genotype, were determined at week 96 and week 144. HCV antibodies were determined by a 3rd-generation ELISA assay. The presence of HCV RNA was determined using reverse transcriptase polymerase chain reaction (AMPLICOR Hepatitis C Virus Test). HCV genotype was analyzed by reverse transcriptase polymerase chain reaction followed by hybridization of amplified products. The biochemical data were recorded every 24 weeks during the follow-up period. Results The 5 patients (35.7%), who achieved sustained viral response (SVR), remained HCV RNA negative at week 96. At week 144, 4 hemodialysis patients (28.6%) remained HCV RNA negative. There was a relapse of HCV infection in 1 patient after week 96 of the study. The patients who remained HCV RNA negative also maintained the achieved biochemical response throughout the follow-up period. Conclusion Long-term follow-up of treated hemodialysis patients with pegylated interferon α-2a showed persistence of the sustained viral and biochemical response.
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Affiliation(s)
| | - Arben Asani
- University Clinic of Nephrology, Skopje - Macedonia
| | | | - Saso Gelev
- University Clinic of Nephrology, Skopje - Macedonia
| | | | - Vili Amitov
- University Clinic of Nephrology, Skopje - Macedonia
| | | | | | - Sami Mena
- Institute of Nephrology, Struga - Macedonia
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31
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Khan MN, Elderdery A. Alterations of Hematological Parameters, Hemoglobin and Hematocrit With Liver Enzymes, Aspartate Transaminase and Alanine Transaminase Among Patients With Chronic Kidney Disease Undergoing Hemodialysis in Aljouf Region, Saudi Arabia. J Hematol 2018; 7:1-6. [PMID: 32300404 PMCID: PMC7155855 DOI: 10.14740/jh367w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 11/11/2022] Open
Abstract
Background Anemia results from low kidney production of the erythropoiesis-stimulant erythropoietin. Good liver function is crucial to patients with chronic kidney disease (CKD). This study analyzed two hematological parameters (hemoglobin (Hb) and hematocrit (Ht)) and two liver enzymes, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in patients with CKD undergoing hemodialysis (HD). Methods Three hundred and thirty individuals participated in this study. Of them, 159 patients with CKD undergoing HD and 171 healthy individuals as a control group were recruited between January and October 2017. Blood was collected into EDTA containers for complete blood count (CBC) and into additive plain containers for ALT and AST. Relevant case history data were also taken. Results Obtained results for first and second month of Hb, Ht, AST and ALT of CKD patients undergoing HD were lower (10.2 g/dL and 8.9 for Hb; 27.2% and 24.8% for Ht; 17.8 IU/L and 15.6 IU/L for ALT; 13.9 IU/L and 12.0 IU/L for AST, respectively) (P < 0.05) compared to healthy individuals (15.1 g/dL for Hb; 44.6% for Ht; 28.3 IU/L for ALT and 23.0 IU/L for AST). Furthermore, Hb, Ht, AST and ALT levels were significantly lower (P < 0.05) in their second month compared to the first month. Conclusions Anemia might emerge in CKD patients because of low Hb concentration and consequent low Ht. Advanced stage CKD causes decreased AST and ALT, as a result of lipid metabolism disturbances. Therefore, anemia and liver diseases are recommended to be treated in CKD patients to alleviate related complications. Renal transplantation must be performed earlier for them to avoid further complications.
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Affiliation(s)
- Mohammad N Khan
- College of Applied Medical Science, Aljouf University, Saudi Arabia
| | - Abozer Elderdery
- College of Applied Medical Science, Aljouf University, Saudi Arabia.,Department of Haematology, Faculty of Medicine and Health Sciences, University of El Imam El Mahdi, Sudan
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32
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Liljedahl L, Norlin J, McGuire JN, James P. Effects of insulin and the glucagon-like peptide 1 receptor agonist liraglutide on the kidney proteome in db/db mice. Physiol Rep 2017; 5:5/6/e13187. [PMID: 28330952 PMCID: PMC5371560 DOI: 10.14814/phy2.13187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 02/09/2017] [Indexed: 01/04/2023] Open
Abstract
Diabetes mellitus (DM) is a worldwide disease that affects 9% of the adult world population and type 2 DM accounts for 90% of those. A common consequence of DM is kidney complications, which could lead to kidney failure. We studied the potential effects of treatment with insulin and the glucagon-like peptide 1 receptor (GLP-1R) agonist liraglutide on the diabetic kidney proteome through the use of the db/db mouse model system and mass spectrometry (MS). Multivariate analyses revealed distinct effects of insulin and liraglutide on the db/db kidney proteome, which was seen on the protein levels of, for example, pterin-4 α-carbinolamine dehydratase/dimerization cofactor of hepatocyte nuclear factor-1α (PCBD1), neural precursor cell expressed developmentally down-regulated-8 (NEDD8), transcription elongation factor-B polypeptide-1 (ELOC) and hepcidin (HEPC). Furthermore, the separation of the insulin, liraglutide and vehicle db/db mouse groups in multivariate analyses was not mainly related to the albumin excretion rate (AER) or the level of glycated hemoglobin A1c (HbA1c%) in the mice. In summary, we show that insulin and liraglutide give rise to separate protein profiles in the db/db mouse kidney.
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Affiliation(s)
- Leena Liljedahl
- Department of Immunotechnology, Lund University, Lund, Sweden
| | | | | | - Peter James
- Department of Immunotechnology, Lund University, Lund, Sweden
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33
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Davis MI, Chute DF, Chung RT, Sise ME. When and how can nephrologists treat hepatitis C virus infection in dialysis patients? Semin Dial 2017; 31:26-36. [PMID: 28925068 DOI: 10.1111/sdi.12650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Hepatitis C virus (HCV) infection, a major cause of end-stage liver disease, is a common comorbidity in patients on dialysis and causes increased morbidity and mortality. Historically HCV has been extremely difficult to cure with interferon and ribavirin-based therapies, which are also associated with significant side effects, and few dialysis patients ever received HCV treatment. However, in the last 4 years, interferon-free direct-acting antiviral therapies have been approved, and several combinations have been studied in dialysis patients. A recently approved, pan-genotypic, direct-acting antiviral regimen, glecaprevir and pibrentasvir, may simplify prescribing. The simplicity of these new therapies, with few side effects, makes it possible for nephrologists to treat HCV infection in their patients on dialysis. We review the workflow and motivation behind nephrology-led management of HCV infection. We highlight the importance of identifying which patients need referral to a hepatologist or HCV specialist prior to treatment and which can be managed by their nephrologist. Nephrologist involvement would lead to improved access to treatment and ensure that appropriate patients are referred for HCV treatment. In this paper, we review the background of HCV infection, its effect on dialysis patients, and impact on kidney transplantation. In addition, we outline the therapy options for each genotype of HCV, and we discuss the benefits and barriers to nephrology-led HCV treatment.
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Affiliation(s)
- Maya I Davis
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Donald F Chute
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Raymond T Chung
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Marinaki S, Kolovou K, Sakellariou S, Boletis JN, Delladetsima IK. Hepatitis B in renal transplant patients. World J Hepatol 2017; 9:1054-1063. [PMID: 28951777 PMCID: PMC5596312 DOI: 10.4254/wjh.v9.i25.1054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 07/18/2017] [Accepted: 08/16/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatitis B virus (HBV) poses a significant challenge for both dialysis patients and kidney transplant recipients despite its decreasing rates, especially in developed countries. The best preventive method is vaccination. Patients with chronic renal disease should ideally be vaccinated prior to dialysis, otherwise, reinforced vaccination practices and close antibody titer monitoring should be applied while on dialysis. HBV infected dialysis patients who are renal transplant candidates must be thoroughly examined by HBV-DNA, and liver enzyme testing and by liver biopsy. When needed, one must consider treating patients with tenofovir or entecavir rather than lamivudine. Depending on the cirrhosis stage, dialysis patients are eligible transplant recipients for either a combined kidney-liver procedure in the case of decompensated cirrhosis or a lone kidney transplantation since even compensated cirrhosis after sustained viral responders is no longer considered an absolute contraindication. Nucleoside analogues have led to improved transplantation outcomes with both long-term patient and graft survival rates nearing those of HBsAg(-) recipients. Moreover, in the cases of immunized HBsAg(-) potential recipients with concurrent prophylaxis, we are enabled today to safely use renal grafts from both HBsAg(+) and HBsAg(-)/anti-HBc(+) donors. In so doing, we avoid unnecessary organ discarding. Universal prophylaxis with entecavir is recommended in HBV kidney recipients and should start perioperatively. One of the most important issues in HBV(+) kidney transplantation is the duration of antiviral prophylaxis. In the absence of robust data, it seems that prophylactic treatment may be discontinued in selected stable, low-risk recipients during maintenance immunosuppression and should be reintroduced when the immune status is altered. All immunosuppressive agents in kidney transplantation can be used in HBV(+) recipients. Immunosuppression is intimately associated with increased viral replication; thus it is important to minimize the total immunosuppression burden long term.
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Affiliation(s)
- Smaragdi Marinaki
- Department of Nephrology and Renal Transplantation Unit, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Kyriaki Kolovou
- Department of Nephrology and Renal Transplantation Unit, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | | | - John N Boletis
- Department of Nephrology and Renal Transplantation Unit, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, 11527 Athens, Greece
| | - Ioanna K Delladetsima
- First Department of Pathology, Medical School, University of Athens, 11527 Athens, Greece
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Lin MS, Chen TH, Lin WY, Liu CH, Hsieh YY, Chiu WN, Chang CH, Chen MY, Chung CM, Lin YS. Add-on neurological benefits of antiviral therapy in HCV patients with chronic kidney disease - a nationwide cohort study. BMC Gastroenterol 2017; 17:99. [PMID: 28814273 PMCID: PMC5559858 DOI: 10.1186/s12876-017-0653-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022] Open
Abstract
Background Hepatitis C virus (HCV)-infected patients with chronic kidney disease (CKD) have rarely been studied because they rarely accept interferon-based therapy (IBT) and have been difficult to follow up. We investigated long-term outcomes of IBT on the population. Methods This population-based cohort study used the Taiwan National Health Insurance Research Database as its data source. HCV patients diagnosed with CKD between Jan. 1, 2003, and Dec. 31, 2013, were selected. They were then divided into two groups based on whether they had undergone IBT. All-cause mortality, acute myocardial infarction (AMI), ischemic stroke (IS), hemorrhagic stroke, and new-onset dialysis were evaluated using a Cox proportional hazard regression analysis after propensity score matching. Results We enrolled 9872 HCV patients with CKD: 1684 patients in the treated cohort and 8188 patients in the untreated cohort. The annual incidence of all-cause mortality (19.00 vs. 42.89 events per 1000 person-years; p < 0.001) and the incidences of hemorrhagic stroke (1.21 vs. 4.19 events per 1000 person-years; p = 0.006) were lower in the treated cohort. New-onset dialysis was also lower in the treated cohort (aHR: 0.31; 95% CI: 0.20–0.48; p < 0.001). Conclusion Antiviral therapy might provide protective benefits on all-cause mortality, hemorrhagic stroke, and new-onset dialysis in HCV-infected patients with CKD. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0653-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ming-Shyan Lin
- Department of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Tien-Hsing Chen
- Department of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Keelung, Taiwan
| | - Wey-Yil Lin
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Yu Hsieh
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wen-Nan Chiu
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital, Yunlin, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney research center, Chang Gung Memorial Hospital, Chang Gung University, College of medicine, Taoyuan, Taiwan
| | - Mei-Yen Chen
- College of Nursing, Chang Gung University of Science and Technology (CGUST), Taoyuan, Taiwan.,Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Min Chung
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan. .,Department of Cardiology, Chiayi Chang Gung Memorial Hospital, 6, Sec. West Chai-Pu Road, Pu-TZ City, Chai Yi Hsien, 61363, Taiwan.
| | - Yu-Sheng Lin
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan. .,Department of Cardiology, Chiayi Chang Gung Memorial Hospital, 6, Sec. West Chai-Pu Road, Pu-TZ City, Chai Yi Hsien, 61363, Taiwan.
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Komitova RT, Atanasova MV, Pavlova TA, Nyagolov MS, Ivanova AV. Diagnostic Dilemmas in Hepatitis C Virus Infection for Hemodialysis Patients. Folia Med (Plovdiv) 2017; 59:70-77. [PMID: 28384106 DOI: 10.1515/folmed-2017-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/20/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a leading cause of chronic hepatitis in dialysis patients. The diagnosis of HCV infection in these patients is predominantly based on laboratory tests because of the specificity of the clinical course of the disease. AIM The present prospective study aimed at determining very accurately the prevalence rate of HCV infection in patients on dialysis by simultaneously testing them for anti-HCV and for HCV RNA levels. MATERIALS AND METHODS For the present cross-sectional longitudinal study we recruited and followed up 93 patients from St George University Hospital Hemodialysis Unit between July 2013 and December 2014. All patients were tested for anti-HCV and HCV RNA. The anti-HCV negative patients were tested for anti-HCV and HCV RNA at least twice at intervals of 6 months or more (up to 12 months). Anti-HCV antibodies were identified using a third generation ELISA assay. Commercial kits for real-time polymerase chain reaction (RT-PCR) were used to detect HCV RNA in the plasma and mononuclear cells. Aminotransferase and gammaglutamyl transpeptidase levels were studied to find if liver inflammation was present. RESULTS The total seroprevalence in 68 patients was 20.6% (14). Of these, 10 patients were viremic (HCV RNA+/anti-HCV+), and 4 patients (5.9%) had discordant results (anti-HCV+/HCV RNA-). Acute hepatitis was detected in one patient. Duration of dialysis in HCV viremic patients was longer than that in aviremic patients (p=0.005). CONCLUSIONS The present study suggests that HCV infection in dialysis patients can be diagnosed more accurately if these patients are tested using two diagnostic methods - a serological test and a biomolecular assay. Further studies with larger sample size may prove the feasibility of such approach for all dialysis patients in this country.
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Affiliation(s)
- Radka T Komitova
- Department of Infectious Diseases, Parasitology and Tropical Medicine, Faculty of Medicine, Medical University of Plovdiv, 15A Vassil Aprilov Blvd., 4002 Plovdiv, Bulgaria
| | - Maria V Atanasova
- Department of Microbiology and Immunology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv
| | | | - Monica Sh Nyagolov
- Clinic of Gastroenterology, Laboratory of Porphyrias and Molecular Diagnostics of Liver Diseases, St Ivan Rilski University Hospital, Sofia
| | - Aneta V Ivanova
- Clinic of Gastroenterology, Laboratory of Porphyrias and Molecular Diagnostics of Liver Diseases, St Ivan Rilski University Hospital, Sofia
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Goodkin DA, Bieber B, Jadoul M, Martin P, Kanda E, Pisoni RL. Mortality, Hospitalization, and Quality of Life among Patients with Hepatitis C Infection on Hemodialysis. Clin J Am Soc Nephrol 2017; 12:287-297. [PMID: 27908905 PMCID: PMC5293341 DOI: 10.2215/cjn.07940716] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/19/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Hepatitis C virus (HCV) infection is widely prevalent among patients on hemodialysis (HD), but very rarely treated. The aim of our study is to evaluate the burdens of HCV suffered by patients on HD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Dialysis Outcomes and Practice Patterns Study is an international, prospective, cohort study of patients on HD. We reviewed the HCV status of 76,689 adults enrolled between 1996 and 2015. We compared HCV-positive (HCV+) with HCV-negative (HCV-) patients for risk of mortality, hospitalization, decline in hemoglobin concentration <8.5 g/dl, and red blood cell transfusion. We also compared health-related quality of life scores using the Kidney Disease Quality of Life instrument and the Center for Epidemiologic Studies Short Depression Scale. We adjusted for age, sex, race, years on dialysis, 14 comorbid conditions (including hepatitis B infection), and serum albumin, phosphorus, and creatinine concentrations. RESULTS A total of 7.5% of patients were HCV+ at enrollment. Serum concentrations of alanine aminotransferase and aspartate aminotransferase were not markedly elevated in HCV+ patients on HD; the mean concentrations were only 22.6 and 21.8 U/L, respectively. Median follow-up was 1.4 years. Case-mix adjusted hazard ratios (95% confidence intervals) for HCV+ versus HCV- patients were 1.12 (1.05 to 1.20) for all-cause mortality, 5.90 (3.67 to 9.50) for hepatic-related mortality, 1.09 (1.04 to 1.13) for all-cause hospitalization, and 4.40 (3.14 to 6.15) for hepatic-related hospitalization. Quality of life measures indicated significantly worse scores for physical function, pain, vitality, mental health, depression, pruritus, and anorexia among HCV+ patients. The adjusted hazard ratio for transfusion was 1.36 (95% CI, 1.20 to 1.55) and incidence of hemoglobin concentration <8.5 g/dl was 1.12 (95% CI, 1.03 to 1.21). Only 1.5% of HCV+ patients received antiviral medication. CONCLUSIONS HCV infection among patients on HD is associated with higher risk of death, hospitalization, and anemic complications, and worse quality of life scores. Internationally, HCV infection is almost never treated in patients on HD. Our data provide a rationale for more frequent treatment of HCV in this population.
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Affiliation(s)
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Michel Jadoul
- Division of Nephrology, Cliniques Universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Paul Martin
- Division of Hepatology, University of Miami, Miami, Florida; and
| | - Eiichiro Kanda
- Department of Nephrology, Tokyo Kyosai Hospital, Tokyo, Japan
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Hepatitis C Virus Infection in Patients with End-Stage Renal Disease: A Study from a Tertiary Care Centre in India. J Clin Exp Hepatol 2016; 6:21-5. [PMID: 27194892 PMCID: PMC4862010 DOI: 10.1016/j.jceh.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 04/19/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C Virus (HCV) infection is common in patients with end stage renal disease (ESRD) and is an important cause of liver disease. We describe the demographic, clinical and biochemical profile of these patients from a tertiary care center of north India. METHODS Records of consecutive patients of HCV infection with ESRD on maintenance hemodialysis or with renal transplantation who presented to our unit from January 2009 to June 2013 were analyzed. The diagnosis of HCV was based on HCV-RNA positivity and/or positive anti-HCV serology. Those with positive anti-HCV serology and negative HCV-RNA on two occasions at 3-month interval, without treatment with interferon, were excluded. RESULTS 140 patients (median age 44 years [range 18-68], 69% males) were included. Six patients had co-infections (HBV 5, HIV 1). Most (99, 71%) patients were asymptomatic for liver disease and HCV was identified either on routine screening (39, 28%) or during investigation for raised liver enzymes (60, 43%). Remaining 41 (29%) were symptomatic for liver disease, either in the form of jaundice alone (14, 10%), or decompensated liver disease (27, 19%). Median time between initiation of hemodialysis and HCV detection was 33 (range 0-124) months. Thirty-four (27%) patients had received renal transplantation. In 11 patients HCV was detected after renal transplantation. In 23 (18%) patients anti-HCV was falsely negative but HCV-RNA was positive. Nearly 35% patients had concomitant diabetes. Median Bilirubin, AST, and ALT were 1.1 mg/dL, 42 IU/L and 44 IU/L, respectively. HCV-RNA was more than 5 log in 49/88(59%) patients. Median HCV-RNA was 6.5 × 10(5) IU/ml (Range 650 to >10 million IU/ml). Genotype-1 was the commonest genotype (30/56, 54%) followed by genotype-3 (17/56, 30%). CONCLUSION HCV infection is usually asymptomatic in patients with ESRD, however, it may lead to jaundice and decompensated liver disease. False negative anti-HCV is quite common. We found that genotype-1 was commoner than genotype-3 in our cohort of ESRD patients. Most of the patients have high viral load.
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Key Words
- ACLF, acute-on-chronic liver failure
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- ESRD
- ESRD, end stage renal disease
- GI, gastrointestinal
- HCC, hepatocellular carcinoma
- HCV
- HCV, hepatitis C virus
- Hb, hemoglobin
- INR, international normalized ratio
- PT, prothrombin time
- RNA, ribonucleic acid
- RT, renal transplantation
- USG, ultrasonography
- genotype
- hemodialysis
- renal transplant
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Lack of impact of hepatitis C virus infection on graft survival after kidney transplantation--a Portuguese single-center experience. Transplant Proc 2016; 47:926-32. [PMID: 26036487 DOI: 10.1016/j.transproceed.2015.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatitis C virus infection (HCV) is a common problem among kidney transplant (KT) recipients. The long-term burden of HCV infection on graft survival after kidney transplantation is controversial. METHODS We performed a retrospective study including all renal transplant recipients with HCV infection (n = 34) compared with a control group (n = 80). The prevalence of HCV infection was 2.7%. The median follow-up period was 134 months (11 years). Graft survival and associated risk factors were assessed by means of Cox proportional hazard analysis. RESULTS We found that HCV-positive patients remained on dialysis for longer periods (P = .001) and received transplants at a younger age (P = .03). Actuarial graft survival rates at 1, 5, and 10 years after KT were, respectively, 94.1%, 78.1%, and 66.9%, in the HCV-positive group and 94.9%, 89.1%, and 80.4% in the HCV-negative group. Graft survival did not differ significantly between groups (P = .154). A higher incidence of major cardiovascular disease among HCV-positive patients (P = .004) was noted. Multivariate analysis showed that HCV infection was not an important risk factor for graft loss (adjusted hazard ratio, 2.810; 95% confidence interval, 0.925-8.541; P = .069). Among the HCV-positive population, immunosuppression with cyclosporine or azathioprine conveyed better graft survival. CONCLUSIONS Our findings suggest that the long-term impact of HCV infection on graft survival after KT is not significant. KT remains a safe and effective modality of renal replacement in HCV-infected patients with end-stage renal disease.
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Eslamifar A, Ramezani A, Ehteram H, Razeghi E, Ahmadi F, Amini M, Banifazl M, Etemadi G, Keyvani H, Bavand A, Aghakhani A. Occult hepatitis C virus infection in Iranian hemodialysis patients. J Nephropathol 2015; 4:116-20. [PMID: 26457258 PMCID: PMC4596295 DOI: 10.12860/jnp.2015.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/13/2015] [Indexed: 12/18/2022] Open
Abstract
Background: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Low concentrations of HCV-RNA may be detected in PBMCs of hemodialysis (HD) patients and this could have a great impact on the management of HD patients.
Objectives: The aim of this study was to detect the occult HCV infection in Iranian HD patients.
Patients and Methods: A total of 70 anti-HCV negative HD patients from three dialysis units in Tehran, Iran were included in this study. In these cases, presence of HCV-RNA in plasma samples was tested by reverse transcriptase-nested polymerase chain reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA, genomic HCV-RNA was checked in PBMC specimens by RT-nested PCR.
Results: Seventy anti-HCV negative HD patients were enrolled in the study. 32.85% and 1.43% of cases had elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) respectively. 7.14% of patients had elevated levels of both ALT and AST. HCV-RNA was negative in plasma samples of all anti-HCV negative HD subjects. The genomic HCV-RNA was not detected in any PBMC samples of HD cases with negative anti-HCV and plasma HCV-RNA.
Conclusions: Occult HCV infection was not detected in our HD patients despite of elevated levels of liver enzymes in some participants. Further studies involving larger number of HD patients are required to elucidate the rate of occult HCV infection in HD cases.
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Affiliation(s)
- Ali Eslamifar
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
| | - Amitis Ramezani
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
| | - Hassan Ehteram
- Department of Pathology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Effat Razeghi
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farrokhlagha Ahmadi
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Manouchehr Amini
- Nephrology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Banifazl
- Iranian Society for Support of Patients with Infectious Diseases, Tehran, Iran
| | | | - Hossein Keyvani
- Department of Virology, Iran University of Medical Sciences, Tehran, Iran
| | - Anahita Bavand
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
| | - Arezoo Aghakhani
- Clinical Research Department, Pasteur Institute of Iran, Tehran, Iran
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Helaly GF, El Ghazzawi EF, Shawky SM, Farag FM. Occult hepatitis B virus infection among chronic hemodialysis patients in Alexandria, Egypt. J Infect Public Health 2015; 8:562-9. [PMID: 26026236 DOI: 10.1016/j.jiph.2015.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/05/2015] [Accepted: 04/03/2015] [Indexed: 12/18/2022] Open
Abstract
The prevalence of end-stage renal disease has increased dramatically in developing countries. Hepatitis B virus (HBV) infection is a global health problem that represents a significant co-morbidity event that has led to outbreaks of hepatitis B. There are inadequate data concerning occult HBV infection among Egyptian chronic hemodialysis patients. This study aimed to detect occult HBV infection among chronic hemodialysis patients in Alexandria, Egypt. A cross-sectional study was performed on 100 patients with end-stage renal disease that received maintenance hemodialysis and had tested negative for HBV surface antigen. Blood samples were collected before the initiation of hemodialysis. Sera were tested for hepatitis C virus (HCV) and hepatitis B core (HBc) antibodies using ELISA, and HBV DNA was detected by SYBR Green real-time PCR using specific primers for the s and c genes and by nested PCR using pol gene-specific primers. The serum activity of alanine and aspartate aminotransferase (ALT and AST) were also measured. Anti-HCV and anti-HBc antibodies were detected in 34% and 48% of patients, respectively, and 70.6% of anti-HCV positive patients were also positive for anti-HBc antibodies. This association was statistically significant (p=0.001). HBV DNA was detected in 32% of the hemodialysis patients. A significant association was determined between the presence of HBV DNA and anti-HCV positivity (p=0.021). Aminotransferases were elevated in 21% of the studied patients, more often in patients with positive anti-HCV profiles than in patients negative for anti-HCV (p<0.05). In conclusion, the serological markers of HBV infection should be verified with molecular tests to investigate possible occult infections, especially among anti-HBc-positive hemodialysis patients, to improve our understanding of their clinical, laboratory, and epidemiological characteristics.
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Affiliation(s)
- Ghada F Helaly
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt.
| | - Ebtisam F El Ghazzawi
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sherine M Shawky
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Farag M Farag
- Department of Microbiology, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Sette LHBC, de Almeida Lopes EP. The reduction of serum aminotransferase levels is proportional to the decline of the glomerular filtration rate in patients with chronic kidney disease. Clinics (Sao Paulo) 2015; 70:346-9. [PMID: 26039951 PMCID: PMC4449464 DOI: 10.6061/clinics/2015(05)07] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 02/13/2015] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study sought to determine the serum aminotransferase levels of patients with predialysis chronic kidney disease and establish their relationships with serum creatinine levels and glomerular filtration rate. METHODS Patients with chronic kidney disease were evaluated between September 2011 and May 2012. Aminotransferase and creatinine serum levels were measured using an automated kinetic method, and glomerular filtration rates were estimated using the Cockroft-Gault and Modification of Diet in Renal Disease formulas to classify patients into chronic kidney disease stages. RESULTS Exactly 142 patients were evaluated (mean age: 64±16 years). The mean creatinine serum level and glomerular filtration rate were 3.3±1.2 mg/dL and 29.1±13 mL/min/1.73 m2, respectively. Patients were distributed according to their chronic kidney disease stages as follows: 3 (2.1%) patients were Stage 2; 54 (38%) were Stage 3; 70 (49.3%) were Stage 4; and 15 (10.5%) were Stage 5. The mean aspartate aminotransferase and alanine aminotransferase serum levels showed a reduction in proportion to the increase in creatinine levels (p=0.001 and p=0.05, respectively) and the decrease in glomerular filtration rate (p=0.007 and p=0.028, respectively). Alanine aminotransferase and aspartate aminotransferase serum levels tended to be higher among patients classified as stage 2 or 3 compared with those classified as stage 4 or 5 (p=0.08 and p=0.06, respectively). CONCLUSIONS The aspartate aminotransferase and alanine aminotransferase serum levels of patients with predialysis chronic kidney disease decreased in proportion to the progression of the disease; they were negatively correlated with creatinine levels and directly correlated with glomerular filtration rate.
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EXP CLIN TRANSPLANTExp Clin Transplant 2015; 13. [DOI: 10.6002/ect.mesot2014.o140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Marinaki S, Boletis JN, Sakellariou S, Delladetsima IK. Hepatitis C in hemodialysis patients. World J Hepatol 2015; 7:548-558. [PMID: 25848478 PMCID: PMC4381177 DOI: 10.4254/wjh.v7.i3.548] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/10/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Despite reduction of hepatitis C prevalence after recognition of the virus and testing of blood products, hemodialysis (HD) patients still comprise a high risk group. The natural history of hepatitis C virus (HCV) infection in dialysis is not fully understood while the clinical outcome differs from that of the general population. HD patients show a milder liver disease with lower aminotransferase and viral levels depicted by milder histological features on liver biopsy. Furthermore, the “silent” clinical course is consistent with a slower disease progression and a lower frequency of cirrhosis and hepatocellular carcinoma. Potential explanations for the “beneficial” impact of uremia and hemodialysis on chronic HCV infection are impaired immunosurveillance leading to a less aggressive host response to the virus and intradialytic release of “hepatoprotective” cytokines such as interferon (IFN)-α and hepatocyte growth factor. However, chronic hepatitis C is associated with a higher liver disease related cardiovascular and all-cause mortality of HD patients. Therapy is indicated in selected patients groups including younger patients with low comorbidity burden and especially renal transplant candidates, preferably after performance of a liver biopsy. According to current recommendations, choice of treatment is IFN or pegylated interferon with a reported sustained viral response at 30%-40% and a withdrawal rate ranging from 17% to 30%. New data regarding combination therapy with low doses of ribavirin which provide higher standard variable rates and good safety results, offer another therapeutic option. The new protease inhibitors may be the future for HCV infected HD patients, though data are still lacking.
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Scotto G, Aucella F, Grandaliano G, Martinelli D, Querques M, Gesuete A, Infante B, Carri PD, Massa S, Salatino G, Bulla F, Fazio V. Hepatitis E in hemodialysis and kidney transplant patients in south-east Italy. World J Gastroenterol 2015; 21:3266-3273. [PMID: 25805933 PMCID: PMC4363756 DOI: 10.3748/wjg.v21.i11.3266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/04/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the serovirological prevalence and clinical features of hepatitis E virus (HEV) infection in end-stage renal failure patients and in the healthy population.
METHODS: HEV infection is a viral disease that can cause sporadic and epidemic hepatitis. Previous studies unexpectedly showed a high prevalence of HEV antibodies in immunosuppressed subjects, including hemodialysis (HD) patients and patients who had undergone kidney transplant. A cohort/case-control study was carried out from January 2012 to August 2013 in two hospitals in southern Italy (Foggia and S. Giovanni Rotondo, Apulia). The seroprevalence of HEV was determined in 801 subjects; 231 HD patients, 120 renal transplant recipients, and 450 health individuals. All HD patients and the recipients of renal transplants were attending the Departments of Nephrology and Dialysis at two hospitals located in Southern Italy, and were included progressively in this study. Serum samples were tested for HEV antibodies (IgG/IgM); in the case of positivity they were confirmed by a Western blot assay and were also tested for HEV-RNA, and the HEV genotypes were determined.
RESULTS: A total of 30/801 (3.7%) patients were positive for anti-HEV Ig (IgG and/or IgM) and by Western blot. The healthy population presented with a prevalence of 2.7%, HD patients had a prevalence of 6.0%, and transplant recipients had a prevalence of 3.3%. The overall combined HEV-positive prevalence in the two groups with chronic renal failure was 5.1%. The rates of exposure to HEV (positivity of HEV-IgG/M in the early samples) were lower in the healthy controls, but the difference among the three groups was not statistically significant (P > 0.05). Positivity for anti-HEV/IgM was detected in 4/30 (13.33%) anti-HEV Ig positive individuals, in 2/14 HD patients, in 1/4 transplant individuals, and in 1/12 of the healthy population. The relative risk of being HEV-IgM-positive was significantly higher among transplant recipients compared to the other two groups (OR = 65.4, 95%CI: 7.2-592.7, P < 0.001), but the subjects with HEV-IgM positivity were numerically too few to calculate a significant difference. No patient presented with chronic hepatitis from HEV infection alone.
CONCLUSION: This study indicated a higher, but not significant, circulation of HEV in hemodialysis patients vs the healthy population. Chronic hepatitis due to the HEV virus was not observed.
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Ray L, Nanda SK, Chatterjee A, Sarangi R, Ganguly S. A comparative study of serum aminotransferases in chronic kidney disease with and without end-stage renal disease: Need for new reference ranges. Int J Appl Basic Med Res 2015; 5:31-5. [PMID: 25664265 PMCID: PMC4318098 DOI: 10.4103/2229-516x.149232] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/30/2014] [Indexed: 12/18/2022] Open
Abstract
Background: Hepatic diseases are common among chronic kidney disease patients and liver function tests particularly serum liver enzymes play an important role in diagnosing and monitoring these patients. Serum aminotransferase levels commonly fall near the lower end of the range of the normal values in patients of chronic kidney disease (CKD). High-levels of serum alkaline phosphatase (ALP) can occur in these patients due to renal osteodystrophy. Thus, the recognition of liver damage in these patients is challenging. Aim: To compare the levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and ALP among three groups - CKD patients without end stage renal disease (ESRD), patients with ESRD and healthy controls. Materials and Methods: A retrospective, hospital-based study was carried out from 100 patients’ records from each group and serum AST, ALT and ALP values were noted. Results: Our study showed that serum AST and ALT levels were significantly lower in CKD patients both without and with ESRD compared to controls. Further, these two enzyme levels were also significantly lower in CKD patients with ESRD compared to CKD patients without the condition. Serum ALP levels were significantly higher in patients with and without ESRD as compared to the controls. However, the values did not differ significantly between patients with and without ESRD. Conclusion: Levels of serum aminotransferases were low in CKD with and without ESRD and the levels become lower as the severity of CKD increases. Thus, the study established the need for separate reference ranges of serum aminotransferase in different stages of CKD.
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Affiliation(s)
- Lopamudra Ray
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Sunil Kumar Nanda
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Anirban Chatterjee
- Department of Occupational Health, Tata Consultancy Services, Eastern Regional Operations, Kolkata, West Bengal, India
| | - Rajlaxmi Sarangi
- Department of Biochemistry, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Satyaki Ganguly
- Department of Dermatology, Venereology and Leprosy, Pondicherry Institute of Medical Sciences, Puducherry, India
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Vidales-Braz BM, da Silva NMO, Lobato R, Germano FN, da Mota LD, Barros EJG, de Martinez AMB. Detection of hepatitis C virus in patients with terminal renal disease undergoing dialysis in southern Brazil: prevalence, risk factors, genotypes, and viral load dynamics in hemodialysis patients. Virol J 2015; 12:8. [PMID: 25644891 PMCID: PMC4329191 DOI: 10.1186/s12985-015-0238-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/02/2015] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED Hepatitis C (HCV) is a serious public health issue, and it is estimated that 3% of the world's population is infected. Patients in hemodialysis units have an increased risk for contracting HCV, and high prevalence rates have been found in hemodialysis units around the world. This study is aimed at determining the prevalence of HCV in patients with terminal chronic renal disease (tCRD) who have been submitted to hemodialysis and peritoneal dialysis in southern Brazil to characterize the most prevalent genotypes, the viral load, and possible risk factors and to assess the validity between the ELISA and RT-PCR detection methods. Of 320 patients from three dialysis units, 318 participated in this study. According to the medical records, 55 patients were reactive to HCV, as determined via ELISA. All 318 samples were submitted to RT-PCR and genotyped using an Abbott Realtime m2000 system. Data obtained through a questionnaire and chemical variables were associated with the HCV. RESULTS The prevalence of HCV was 18.24% (58), and the concordance between the HCV serology and the RT-PCR was 94%. Three patients were diagnosed to be negative for HCV using the ELISA assay but positive when using RT-PCR. Genotype 1 was the most prevalent (46.7%) genotype, within which subtype 1a was the most frequent (74.1%). One of the risk factors associated with HCV infection was the length of time that the patient had been undergoing hemodialysis treatments (p < 0.001). Additionally, the viral load was found to vary when tested before and after hemodialysis (p < 0.001). CONCLUSION The prevalence of HCV in dialysis units continues to remain high, indicating nosocomial contamination. RT-PCR detected the presence of the hepatitis C virus in patients with a non-reactive serology, which highlights the importance of performing molecular tests on dialysis patients. The variation in the viral load in patients submitted to hemodialysis indicates a possible destruction or gripping of viral particles to the dialyzer membrane.
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Affiliation(s)
| | | | - Rubens Lobato
- Federal University of Rio Grande (FURG), Rio Grande, Brazil.
| | | | | | - Elvino J G Barros
- Federal University of Rio Grande do Sul (UFRGS), Porto alegre, Brazil.
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Vespasiani-Gentilucci U, Gallo P, Piccinocchi G, Piccinocchi R, Schena E, Galati G, De Vincentis A, Dell'Unto C, Picardi A. Determinants of alanine aminotransferase levels in a large population from Southern Italy: relationship between alanine aminotransferase and age. Dig Liver Dis 2014; 46:909-15. [PMID: 24953204 DOI: 10.1016/j.dld.2014.05.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 05/19/2014] [Accepted: 05/25/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Determinants of alanine aminotransferase levels have never been investigated in real-life settings. The relationship between alanine aminotransferase and age remains controversial. We evaluated epidemiological, anthropometric, and metabolic factors associated with alanine aminotransferase, focusing on the relationship between alanine aminotransferase and age. METHODS A 5-year retrospective analysis was performed on data recorded by 120 general practitioners from Naples (Italy), caring for 170,000 subjects. Exclusion criteria were age <18 years, diagnosis of chronic liver disease, positive markers for viral hepatitis, alcohol abuse, and alanine aminotransferase >100UI/L. RESULTS 44,232 subjects were enrolled (42.7% males, mean age 56±18 years). Alanine aminotransferase showed independent direct associations with body mass index, glycaemia, cholesterol, and triglycerides (p<0.001), and inverse associations with high-density lipoprotein cholesterol (p<0.001) and creatinine (p<0.01). The relationship between alanine aminotransferase and age was better expressed by polynomial regression (r=0.18, p<0.001), creating an inverted parabola. Mean alanine aminotransferase increased until the third decade in males and the fifth in females, with a subsequent progressive decrease in both genders. The inverse association between alanine aminotransferase and age in older subjects was independent from metabolic factors. CONCLUSIONS This real-life setting study, supports the concept that dysmetabolism is a strong determinant of liver injury. Based on our data, a reduction of the standard upper limit of normal alanine aminotransferase should be considered for older subjects.
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Affiliation(s)
| | - Paolo Gallo
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico of Rome, Italy
| | | | | | - Emiliano Schena
- Unit of Measurement and Biomedical Instrumentation, University Campus Bio-Medico of Rome, Italy
| | - Giovanni Galati
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico of Rome, Italy
| | - Antonio De Vincentis
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico of Rome, Italy
| | - Chiara Dell'Unto
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico of Rome, Italy
| | - Antonio Picardi
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico of Rome, Italy
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Borlak J, Chougule A, Singh PK. How useful are clinical liver function tests in in vitro human hepatotoxicity assays? Toxicol In Vitro 2014; 28:784-95. [DOI: 10.1016/j.tiv.2014.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 12/11/2022]
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Fabrizi F, Martin P, Dixit V, Messa P. Meta-analysis of observational studies: hepatitis C and survival after renal transplant. J Viral Hepat 2014; 21:314-24. [PMID: 24716634 DOI: 10.1111/jvh.12148] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/18/2013] [Indexed: 12/11/2022]
Abstract
Recent evidence has shown that anti-HCV-positive serologic status is significantly linked to lower patient and graft survival after renal transplant, but conflicting results have been given on this point. The aim of this study was to conduct a systematic review of the published medical literature concerning the impact of HCV infection on all-cause mortality and graft loss after RT. The relative risk of all-cause mortality and graft loss was regarded as the most reliable outcome end-point. Study-specific relative risks were weighted by the inverse of their variance to obtain fixed- and random-effect pooled estimates for mortality and graft loss with HCV across the published studies. We identified eighteen observational studies involving 133 530 unique renal transplant recipients. The summary estimate for adjusted relative risk (aRR) of all-cause mortality was 1.85 with a 95% confidence interval (CI) of 1.49; 2.31 (P < 0.0001); heterogeneity statistics, Ri = 0.87 (P-value by Q-test = 0.001). The overall estimate for adjusted RR of all-cause graft loss was 1.76 (95% CI, 1.46; 2.11) (P < 0.0001), heterogeneity statistics, Ri = 0.65 (P-value by Q-test = 0.001). Stratified analysis did not change meaningfully these results. Meta-regression showed that living donor rate had a favourable influence on patient (P = 0.031) and graft survival (P = 0.01), whilst diabetes mellitus having a detrimental role on patient survival (P = 0.001). This meta-analysis of observational studies supports the notion that HCV-positive patients after RT have an increased risk of mortality and graft loss. Further studies are in progress to understand better the mechanisms underlying the relationship between HCV and mortality or graft dysfunction after renal transplant.
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Affiliation(s)
- F Fabrizi
- Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Milano, Italy; Division of Hepatology, School of Medicine, University of Miami, Miami, FL, USA
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