Reduction of hepatitis C virus load during low flux renal haemodialysis in patients with end stage renal disease infected with HCV

HCV infection remains a common problem in patients with end stage renal disease [ESRD] undergoing maintenance dialysis especially Haemodialysis [HD]. Inspite that dialysis patients usually are not immunologically competent due to uraemia, hepatitis C virus infection runs usually indolent course. A number of studies support the notion that this dynamics of HCV viral load may be related to lowering of HCV RNA titres during the HD procedure that could be related to the dialyser immaterial used. This work aimed mainly to study the change in HCV RNA titre before and after HD session using low flux dialyser. 18 HCV positive, end stage renal disease [ESRD] patients on regular HD with detectable viral RNA using qualitative polymerase chain reaction [PCR] technique were included. All patients had quantitative PCR just before and at the end of a single 4 hours HD session. Standard low flux [Cuprophan or Polysulphon] dialysis filters 1.2m[2] surface area were used for all patients included. Mean HCV RNA for all patients pre dialysis was 135, 143 +/- 16,993 copies/ml. Mean post dialysis HCV RNA was 78, 786 +/- 48,651 copies/ml. Observed reduction in HCV title post/pre dialysis ratio 13.8%-82.l% with median value of +/- 40%. There was a significant reduction in the level of HCV RNA after dialysis [p<0.001, 95% Confidence Interval 125, 332-144, 954]. Low flux haemodialysis session has a significant effect on hepatitis C viral load with marked reduction in HCV RNA that can have a positive impact on the prognosis of hepatitis C in ESRD on regular HD

Effect of haemofiltration in prevention of contrast induced nephropathy and on acid/base status in predialysis chronic kidney disease patients undergoing cardiac catheterization

High risk renal failure patients have increased risk for contrast nephropathy during coronary angiography despite the use of conventional prophylaxis with intravenous hydration and acetylcysteine. The aim of the study was assess the role of haemo filtration versus conventional prophylaxis in preservation of kidney function and prevention of contrast nephropathy in chronic kidney disease patients undergoing cardiac catheterisation. There was a highly significant reduction in BUN, creatinine, serum uric acid [p<0.001] in haemofiltration group in comparison with baseline and control group till day 4 that was not significant after one week. There was a significantly improving rise in pH and serum HCO[3] level in haemofiltration in haemofiltration group till 24 hours post contrast injection [p<0.001]. Haemofiltration can provide adequate pres ervation of kidney function in high risk renal patients under going cardiac catheterisation. It also achieved proper adjustment of acid/base status in such patients