Abstract: TH-PO791

Direct-Acting Antiviral Agents Therapy Reduce Beta2 Microglobulin Levels of Hemodialysis Patients with Hepatitis C Virus Infection

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Author

  • Ito, Minoru, Yabuki Hospital, Yamagata City, Japan
Background

Hepatitis C virus (HCV) infection is still major comorbidity in patients receiving hemodialysis. Recently, the direct-acting antiviral agents (DAAs) against HCV has been allowed to use for end-stage renal disease patients in Japan. Moreover, a prior study reported that HCV infection was related to serum beta2 microglobulin (ß2MG) elevation. ß2MG is known as a causative substance of dialysis-related amyloidosis (DRA). In this study, we evaluated the ß2MG lowering effect of the DAAs therapy to hemodialysis patients with HCV infection.

Methods

We treated sixteen HCV (Serotype 1)-infected hemodialysis patients with DAAs between October 2015 and April 2017. We prescribed daclatasvir and asunaprevir combination for twelve patients, and elbasvir and grazoprevir combination for four patients. We evaluated the sustained virologic response (SVR) and the serum ß2MG level before and after DAAs therapy.

Results

16 patients were enrolled in this study (age: 62.2 years old, dialysis vintage: 20.4 years, male 12, female 4). All the 16 patients completed the DAAs therapy without remarkable side effects. At the end of treatments, all patients had undetectable HCV RNA levels. However, one patient had a virological failure a month after. The serum ß2MG levels before the treatment were higher than the target level that several clinical guidelines recommend. Just after the treatments, the ß2MG levels decreased significantly (30.4 mg/L v.s. 24.8 mg/L, p=0.0016). ß2MG levels of 15 patients with satisfactory results remained lower after several weeks (observational periods) of treatment. A patient with virological failure showed ß2MG level increased again immediately.

Conclusion

ß2MG-removal therapies have developed dramatically. Online-hemodiafiltration, hemodialysis with high-flux membrane and ß2MG apheresis column show high ß2MG removal performance. However, these treatments were insufficient for the patients with HCV infection. In this study, we found the ß2MG lowering effect of DAAs therapy. DAAs therapy is highly likely to prevent DRA for dialysis patients with HCV infection.