Occult hepatitis C virus infection in hemodialysis patients who achieved a sustained virological response to directly acting antiviral drugs: is it a concern?

PURPOSE

Hepatitis C virus infection is a major health problem in hemodialysis patients. Occult HCV infection is defined as the presence of HCV-RNA in hepatocytes or peripheral blood mononuclear cells without the detection of HCV-RNA in the serum. We aimed to evaluate the prevalence and predictors of occult HCV infection among hemodialysis patients after treatment with direct-acting antiviral agents.

METHODS

This research is a cross-sectional study that included 60 HCV patients maintained on regular HD patients who achieved 24 weeks of sustained virological response after treatment with direct-acting antiviral agents. Real-time PCR was performed to detect HCV-RNA in peripheral blood mononuclear cells.

RESULTS

HCV-RNA was detected in peripheral blood mononuclear cells of three patients (5%). Occult HCV infection cases were treated by Interferon/ribavirin before direct-acting antiviral agents and two of them had raised pre-treatment alanine aminotransferase levels. Logistic regression analyses revealed that high pre-treatment viral load and raised pre-treatment alanine aminotransferase were associated with an increased risk of occult HCV infection with p value of 0.041 and 0.029, respectively.

CONCLUSIONS

Occult HCV infection in hemodialysis patients who achieved sustained virological response after treatment with direct-acting antiviral agents may occur, and this may necessitate dual testing for HCV in both serum and peripheral blood mononuclear cells to ensure viral clearance.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov NCT04719338.

The effectiveness of sertraline in alleviating uremic pruritus in hemodialysis patients: a randomized clinical trial

INTRODUCTION

Uremic pruritus (UP) is a common and distressing symptom in end stage renal disease (ESRD) patients. Many approaches have been tested to improve UP without a clear success. We aimed to assess the effect of sertraline on UP in hemodialysis (HD) patients.

METHODS

This research is a double-blinded, placebo-controlled, multicentric randomized clinical trial which included sixty patients maintained on regular HD. Patients were allocated to receive sertraline 50 mg twice daily or placebo for 8 weeks. The Visual analogue scale (VAS) and the 5-D itch scale were used to assess pruritus before and after the course of treatment.

RESULTS

At study end in sertraline group, there was a significant decrease from baseline findings in the VAS score (p < 0.001), and the 5-D itch scale (p < 0.001). On the other hand, in placebo group the VAS score showed a slight non-significant decrease (p = 0.469), and the 5-D scale (p = 0.584) increased from baseline measurements. The percentage of patients with severe and very severe pruritus decreased significantly in the sertraline group in both scores [(VAS score: p = 0.004), (5-D itch score: p = 0.002)] with no significant change in the placebo group [(VAS score: p = 0.739), (5-D itch scale: p = 0.763)]. There was a significant positive relation between the VAS and 5-D itch scores and serum urea with p value of 0.002 and 0.001 respectively, and serum ferritin with p value of < 0.001 with both.

CONCLUSIONS

Patients treated with sertraline had a significant improvement in pruritus as compared with those who received placebo suggesting a potential role for sertraline to treat uremic pruritus in HD patients. Larger randomized clinical trials are needed to confirm these findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05341843. First registration date: 22/04/2022.

Dialysis recovery time: associated factors and its association with quality of life of hemodialysis patients

Introduction

Post-dialysis fatigue is a common and distressing complaint in patients on hemodialysis (HD). The dialysis recovery time (DRT) is a recent and reliable method of Post-dialysis fatigue assessment. We aimed to identify factors affecting the DRT and its relation with HD patients’ quality of life.

Material and methods

This is a cross-sectional study carried out on end-stage renal disease patients on regular HD. All participants underwent detailed history taking and complete physical examination, and data on dialysis and laboratory investigations were also collected. Patients were asked “How long does it take you to recover from a dialysis session?” to calculate the DRT. We used the Malnutrition-Inflammation Score (MIS) and KDQOL-36 questionnaire to assess patients’ nutritional status and quality of life, respectively.

Results

Two hundred and ten patients were screened and 191, with a median age of 47 years, completed the study. Patients had a median DRT of 300 minutes (range: 0.0–2880.0), with 55% of patients reporting a DRT of > 240 minutes and 22.5% of them reporting a DRT of < 30 minutes. Patients had a median MIS score of 7 (range: 0–17). There was a statistically significant negative relation between the DRT and symptom/ problem list (p < 0.001), effects of kidney disease (p < 0.001), burden of kidney disease (p < 0.001), SF-12 physical composite (p = 0.001), and SF-12 mental composite (p < 0.001) of KDQOL. The results of multivariate analyses showed that dialysate Na (p = 0.003), and the number of missed sessions (p < 0.001) were independently correlated with the DRT.

Conclusions

Decreased dialysate Na, and increased number of missed sessions were predictors of prolonged DRT. Patients with prolonged DRT were associated with poorer quality of life. Further randomized clinical trials are needed to assess strategies to minimize the DRT and, perhaps, enhance clinical outcomes.

Trials registration

ClinicalTrials.gov Identifier: NCT04727281. First registration date: 27/01/2021.

Atorvastatin can delay arterial stiffness progression in hemodialysis patients

Purpose

Arterial stiffness is one of the vascular pathologies in hemodialysis (HD) patients with increased cardiovascular mortality and morbidity. Few approaches have been tested to reduce arterial stiffness in patients with chronic kidney disease (CKD). We aimed to assess effects of atorvastatin on arterial stiffness in hemodialysis patients.

Methods

This research is a double-blinded, placebo-controlled, randomized clinical trial which included 50 patients maintained on regular HD. Patients were allocated to receive 10 mg atorvastatin or placebo for 24 weeks. Aortic pulse wave velocity (PWV) as an index of large artery stiffness and augmentation index (AIx) as an index of wave reflections were assessed at baseline and after 6 months in both groups.

Results

In atorvastatin group at study end, there was no significant difference from baseline findings in aortic PWV (7.86 ± 2.5 vs 7.88 ± 2.6 m/sec; p = 0.136), AIx (26.04 ± 8.5 vs 26.0 ± 8.6%; p = 0.714) and central pulse pressure (PP) (p = 1.0). On the other hand, in placebo group after 24 weeks, aortic PWV (7.80 ± 2.16 vs 7.63 ± 2.1 m/sec; p < 0.001), AIx (25.88 ± 9.4 vs 25.04 ± 9.4%; p < 0.001) increased significantly from baseline measurements but central pulse pressure (PP) (p = 0.870) did not. Also, the change (Δ) in aortic PWV and AIx was significantly higher than the change in the atorvastatin group with p value of < 0.001 and < 0.001, respectively.

Conclusions

Arterial stiffness parameters remained stable in atorvastatin group but increased significantly in placebo-treated patients suggesting a potential role for atorvastatin to delay arterial stiffness progression in HD patients. Larger randomized clinical trials are needed to confirm these findings.

Clinical Trials registration

ClinicalTrials.gov NCT04472637.

Effect of laser biostimulation and a low-calorie diet vs. a low-calorie diet alone on insulin resistance, inflammatory biomarkers, and depression among obese postmenopausal women: a randomized controlled trial

OBJECTIVE

Postmenopausal women are significantly predisposed to a multitude of disorders. Laser biostimulation (LB) and a healthy diet have been linked to multiple health benefits. This study aimed to investigate the effect of a combined LB and balanced low-calorie diet (LCD) vs. an LCD alone on insulin resistance (IR), inflammatory biomarkers, and depression score in obese postmenopausal women.

PATIENTS AND METHODS

In the present study, a total of 66 postmenopausal women, with a mean age of 66.61 ± 4.80 years and a body mass index (BMI) of 35.93 ± 2.67 kg/m2, were randomized into two equal groups. The experimental group received LB and LCD (including 50-60% carbohydrates, 15-20% protein, 20-35% fat, and 25 g of fiber/day plus a restriction of 500-1000 kcal/d), while the control group followed the same diet program only for 12 weeks. Before and after the intervention, IR [measured by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR index)], inflammatory biomarkers [C-reactive protein (CRP), white blood cells (WBCs), lymphocytes, and erythrocyte sedimentation rate (ESR)], and depression level [as assessed by the Hamilton Depression Rating Scale (HAMD-17)] were all measured.

RESULTS

Using an intention-to-treat analysis for 60 women who completed the study, the body weight average reduction was -13.14% for the experimental group (p<0.001) vs. -6.36% for the control group (p<0.001). BMI, IR, inflammatory markers, and depression levels were also similarly changed.

CONCLUSIONS

In postmenopausal obese women, adding LB to a suitable dietary program provides the most significant benefit in terms of lowering IR, metabolic inflammation, and depression.

Effect of aerobic exercise with diet on sex hormones and selected coagulation biomarkers in obese postmenopausal women: a randomized clinical trial

OBJECTIVE

The current study determined the effect of aerobic training and diet program versus diet only on sex hormones and selected coagulation biomarkers in obese postmenopausal women. Further, the correlation between the measured variables after the intervention was identified.

PATIENTS AND METHODS

Eligible 40 women were distributed into two equal groups: the experimental group that received aerobic training three times per week for 12 weeks along with a balanced diet, and the control group that received a balanced diet only. Changes in weight, body mass index, sex hormones, and coagulation biomarkers were assessed pre-and post-intervention. The correlation between evaluated variables was assessed.

RESULTS

Both groups demonstrated a significant difference in sex hormones (i.e., a substantial decrease in estradiol, total testosterone, free testosterone, and a substantial increase in sex hormone-binding globulin) and coagulation biomarkers (a considerable reduction in plasminogen activator inhibitor-1 activity, fibrinogen, and a significant increase in tissue plasminogen activator, prothrombin time, and cephalin-kaolin coagulation time). This discrepancy was highly significant in the experimental group (p < 0.01) relative to the control group (p < 0.05), and there was a strong link between sex hormones and coagulation biomarkers (p ≤ 0.05). Conversely, no correlation between variables was noticed in the control group (p > 0.05).

CONCLUSIONS

Aerobic exercise along with a balanced diet modulates sex hormones level, improves homeostasis balance in postmenopausal women, and reduces the potential risk of cardiovascular disease.