الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
There in an intimate relationship between HCV infection and kidney disease.
HCV infection is a cause and complication of kidney disease, both chronic and acute. On one hand, HCV can cause glomerular disease and worsen outcomes in dialysis patients and kidney transplantation recipients. On the other hand, patients on dialysis are at high risk of HCV infection.
Treatment of patients with CKD and CHC differs from that used in the general CHC population, mostly when GFR is below 30 mL/min.
Successful mapping of the HCV genome led to the development of drugs targeting nonstructural components of the virus that are critical for viral replication. The DAA agents deliver SVR rate that routinely exceed 90% after an 8- or 12-week course of therapy course.
The antiviral regimens based on DAA promise to play a pivotal role in eradication of hepatitis C among kidney disease patients.
This study was conducted to assess efficacy and safety of DAA for treating HCV infection in those difficult to treat population.
This study included 100 chronic HCV positive patients with advanced renal disease (e GFR < 30 ml / min). Patient s were devided into two groups: NHD group and HD group.
All of patients received antiviral therapy in the form of Qurevo, a Combination therapy of{ ombitasvir (OBV) plus Paritaprevir (PTV) plus ritonavir ( r)} + ribavirin for 12 weeks.
All cases completed therapy course except one case of NHD group, as she developed acute on top of chronic kidney disease, she was admitted to hospital, received medical care and she was recovered and discharged.
PCR was significantly higher in NHD group than HD group before initiation of therapy course.
SVR12 (viral cure),was achieved in,47, (95.9%) of patients of NHD group and,48, (96%) of patients of HD group,which represent high efficacy rate in those difficult to treat population.
Statistically significant gradual decline in hemoglobin level in both groups was observed along therapy course, which may be attributed to RBV induced hemolytic anemia,also those patients with ESRD suffer from insuffient erythropoietin production and limited ability to excrete RBV.
Serum bilirubin was significantly higher in NHD group than HD group after 2 weeks of therapy but it was normalized or stabilized thereafter, which may be attributed to hemolytic anemia induced by RBV.
No statistical significant differences were observed along therapy course regading most of laboratory findings e.g platelet count,WBC count,INR or serum albumin.
No statistical significant differences in Serum creatinine level or in eGFR of NHD group along therapy course supporting the use of this combination of DAA {ombitasvir (OBV) plus Paritaprevir (PTV) plus ritonavir ( r)} in patients with renal impairment, which is known to be hepatically excreted and did not affect renal functions.
No serious adverse events occurred to patients during therapy course,all events were mild to moderate e.g headach,dizzinss,fatigue or abdominal discomfort and were tolerable to patients.
All cases before study were classified as child A5 and Child A6 regarding Child-Pugh class of liver. Cases of hepatic decompensation (Child–Pugh B or C) were excluded from the begining,no cases of decompansation developed during therapy course or after end of therpy