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

Uremic pruritus: skin ultrastructure and laboratory study

Uremic pruritus is a common cause of morbidity for both hemodialysis [HD] and peritoneal dialysis patients. The pathogenesis is still conflicting. This work was planned to study skin ultrastructure and some biochemical parameters with possible relevance to pruritus including serum urea, creatinine, calcium, phosphorus, alkaline phosphatase, parathyroid hormone [PTH], and calcium-phosphorus products. The effects of dialysis duration, frequency, adequacy, and dialysate buffer were also studied. The study was conducted on 45 persons divided into three groups. Group 1 included 15 patients with CRF on HD with severe pruritus. Group II included 15 patients without pruritus on HD. Group III included 15 normal persons as control. Skin biopsy was performed for ten patients from each of group I and group II patients for electrom microscopic [EM] examination. Uremic pruritus was neither correlated to dialysis duration, frequency, adequacy, nor to dialyste buffer. The serum levels of urea, creatinine, calcium, alkaline phosphatase, and calcium-phosphorus products showed no significant difference between both HD groups. Whereas, serum phosphorus and PTH were significantly higher in both patient groups than controls, and in the pruritic than the non-pruritic HD patients. The present EM study demonstrated increased density of mast cells as well as an increase of mast cell granule size and number. These mast cell changes were common for both patient groups. Sweat glands in the pruritic, but not the non-pruritic group, revealed non-uniform cell morphology with altered villi. The nuclear envelope was irregular with segregation of nucleoli. The skin nerve endings, sebaceous glands and blood vessels were normal in both patient groups. It was concluded that the markedly elevated serum levels of phosphorus and PTH might play a crucial role in the development of pruritus in maintenance HD patients. Also, the co-occurrence of sweat gland changes with increased mast cell number; granularity and granule size could be a marker of uremic pruritus

Hepatitis B vaccination in hemodialysis patients: protective level of HBV antibodies could be achieved by the ordinary schedule?

Hepatits B vaccine is effective in producing protection against hepatitis B virus [HBV] infection in hemodialysis [HD] patients, but the antibody response is variable, so different vaccine regimens were adopted. The aim of the present work is to assess the immune response to HBV vaccine in 67 HD patients receiving 20 micro g of recombinant HBV vaccine / dose for 3 doses, intramuscularly [IM], at 0, 1, and 6- month intervals, compared with 36 medical staff members in the same unit as control receiving the same regimen. The results showed the presence of anti-HBc antibodies in 34 patients and 11 control subjects, those were exculded from the study so as to assess the effect of the vaccine only and not the natural infection. The antibody response is defined as protective when the level of anti-HBs antibodies exceeds or equals to 10 mlU/ml. The response rate was significantly lower in HD patients [51.5%] than in control subjects [96%] [P= 0.0002]. To months after the last dose of the vaccine the difference in seroprotection rate was insigificant being 62.5% in HD patients versus 66.7% in the control [P = 0.89], while after 6 and 12 months, the difference was statistically significant being 56.3%, 33.3% in HD patients versus 100%, and 100% in the control subjects respectively [P = 0.003, 0.006]. On the whole, the levels of anti-HBs, expressed as geometric mean titres and 95% confidence intervals [GMT [95% Cl]], were non-significantly lower in HD patients 125.64 [58.37-269.99] mlU/ml, than controls 239.67 [137.88-416.63] mlU/ml respectively [P = 0.149]. The gender, age, cause of renal failure, HCV co-infection, duration of HD, HD frequency, dialyzer membrane and dialysate buffer did not show a significant influence on the response to HBV vaccine. There were significant positive correlations between the level of anti-HBs antibodies and both serum albumin and predialysis urea [P = 0.00] indicating the improtant role of malnutrition on the poor response to the vaccine in HD patients. From this study it was concluded that the ordinary three-doses regimen is not enough for protection in a good proportion of HD patients, and other regimens should be assessed