High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents
Background Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used f...
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| Veröffentlicht in: | International urology and nephrology 2019-12, Vol.51 (12), p.2243-2254 |
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| description | Background
Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.
Aim
The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.
Methods
Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.
Results
The patients’age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97);
p
= 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35);
p
= 0.001].
Conclusion
Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation. |
| doi_str_mv | 10.1007/s11255-019-02316-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2305795959</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2305795959</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-61b87238de096a7803c8072d50e519ea2b0bcacf9dbee525ae272b2abe2dd9c3</originalsourceid><addsrcrecordid>eNp9kUFvEzEQhS1ERUPbP8ABWeLCxXRsx-vdI4oKRarEpXfLa082Dok32F6i_BD-Lw7bgsQBzWFG8vfes_QIecPhAwfQt5lzoRQD3jEQkjfs-IIsuNKSCdUuX5IFSOCMN0Jektc5bwGgawFekcsKc7EUckF-3odhQ5MtSMc1tW6qx7fgI55oiNspnRc92BIwlkyPoWyo26QxBveM-ZDRZqQ2errBM1pCpiv6I6Qp0wHjWE4HpEtaEtYYP5v4kNAVZl0JcajaEipvd9QO56BrcrG2u4w3T_uKPH66e1zds4evn7-sPj4wJ7UqrOF9q4VsPULXWN2CdC1o4RWg4h1a0UPvrFt3vkdUQlkUWvTC9ii875y8Iu9n20Mav0-Yi9mH7HC3sxHHKRshQelO1anou3_Q7TilWD9XKS6XrZaNrpSYKZfGnBOuzSGFvU0nw8GcOzNzZ6Z2Zn53Zo5V9PbJeur36P9InkuqgJyBXJ_igOlv9n9sfwFPe6T4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2313487367</pqid></control><display><type>article</type><title>High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Elmowafy, Ahmed Yahia ; El Maghrabi, Hanzada Mohamed ; Mashaly, Mohamed Elsayed ; Eldahshan, Khaled Farouk ; Rostaing, Lionel ; Bakr, Mohamed Adel</creator><creatorcontrib>Elmowafy, Ahmed Yahia ; El Maghrabi, Hanzada Mohamed ; Mashaly, Mohamed Elsayed ; Eldahshan, Khaled Farouk ; Rostaing, Lionel ; Bakr, Mohamed Adel</creatorcontrib><description>Background
Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.
Aim
The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.
Methods
Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.
Results
The patients’age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97);
p
= 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35);
p
= 0.001].
Conclusion
Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.</description><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-019-02316-w</identifier><identifier>PMID: 31612423</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Acute Kidney Injury - epidemiology ; Acute Kidney Injury - etiology ; Adult ; Antiviral agents ; Antiviral Agents - therapeutic use ; Antiviral drugs ; Creatinine ; Female ; Genotype ; Genotypes ; Hemodialysis ; Hepacivirus - genetics ; Hepatitis ; Hepatitis C ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - drug therapy ; Hepatitis C, Chronic - virology ; Humans ; Kidney diseases ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate analysis ; Nephrology ; Nephrology - Original Paper ; Pilot Projects ; Prospective Studies ; Renal Insufficiency, Chronic - complications ; Ribavirin ; Risk factors ; Ritonavir ; Safety ; Transplantation ; Ultrasound ; Urology</subject><ispartof>International urology and nephrology, 2019-12, Vol.51 (12), p.2243-2254</ispartof><rights>Springer Nature B.V. 2019</rights><rights>International Urology and Nephrology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-61b87238de096a7803c8072d50e519ea2b0bcacf9dbee525ae272b2abe2dd9c3</citedby><cites>FETCH-LOGICAL-c375t-61b87238de096a7803c8072d50e519ea2b0bcacf9dbee525ae272b2abe2dd9c3</cites><orcidid>0000-0002-5130-7286</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-019-02316-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-019-02316-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31612423$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elmowafy, Ahmed Yahia</creatorcontrib><creatorcontrib>El Maghrabi, Hanzada Mohamed</creatorcontrib><creatorcontrib>Mashaly, Mohamed Elsayed</creatorcontrib><creatorcontrib>Eldahshan, Khaled Farouk</creatorcontrib><creatorcontrib>Rostaing, Lionel</creatorcontrib><creatorcontrib>Bakr, Mohamed Adel</creatorcontrib><title>High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description>Background
Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.
Aim
The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.
Methods
Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.
Results
The patients’age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97);
p
= 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35);
p
= 0.001].
Conclusion
Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.</description><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - etiology</subject><subject>Adult</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Antiviral drugs</subject><subject>Creatinine</subject><subject>Female</subject><subject>Genotype</subject><subject>Genotypes</subject><subject>Hemodialysis</subject><subject>Hepacivirus - genetics</subject><subject>Hepatitis</subject><subject>Hepatitis C</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Hepatitis C, Chronic - virology</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Nephrology</subject><subject>Nephrology - Original Paper</subject><subject>Pilot Projects</subject><subject>Prospective Studies</subject><subject>Renal Insufficiency, Chronic - complications</subject><subject>Ribavirin</subject><subject>Risk factors</subject><subject>Ritonavir</subject><subject>Safety</subject><subject>Transplantation</subject><subject>Ultrasound</subject><subject>Urology</subject><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kUFvEzEQhS1ERUPbP8ABWeLCxXRsx-vdI4oKRarEpXfLa082Dok32F6i_BD-Lw7bgsQBzWFG8vfes_QIecPhAwfQt5lzoRQD3jEQkjfs-IIsuNKSCdUuX5IFSOCMN0Jektc5bwGgawFekcsKc7EUckF-3odhQ5MtSMc1tW6qx7fgI55oiNspnRc92BIwlkyPoWyo26QxBveM-ZDRZqQ2errBM1pCpiv6I6Qp0wHjWE4HpEtaEtYYP5v4kNAVZl0JcajaEipvd9QO56BrcrG2u4w3T_uKPH66e1zds4evn7-sPj4wJ7UqrOF9q4VsPULXWN2CdC1o4RWg4h1a0UPvrFt3vkdUQlkUWvTC9ii875y8Iu9n20Mav0-Yi9mH7HC3sxHHKRshQelO1anou3_Q7TilWD9XKS6XrZaNrpSYKZfGnBOuzSGFvU0nw8GcOzNzZ6Z2Zn53Zo5V9PbJeur36P9InkuqgJyBXJ_igOlv9n9sfwFPe6T4</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Elmowafy, Ahmed Yahia</creator><creator>El Maghrabi, Hanzada Mohamed</creator><creator>Mashaly, Mohamed Elsayed</creator><creator>Eldahshan, Khaled Farouk</creator><creator>Rostaing, Lionel</creator><creator>Bakr, Mohamed Adel</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5130-7286</orcidid></search><sort><creationdate>20191201</creationdate><title>High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents</title><author>Elmowafy, Ahmed Yahia ; El Maghrabi, Hanzada Mohamed ; Mashaly, Mohamed Elsayed ; Eldahshan, Khaled Farouk ; Rostaing, Lionel ; Bakr, Mohamed Adel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-61b87238de096a7803c8072d50e519ea2b0bcacf9dbee525ae272b2abe2dd9c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - etiology</topic><topic>Adult</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Antiviral drugs</topic><topic>Creatinine</topic><topic>Female</topic><topic>Genotype</topic><topic>Genotypes</topic><topic>Hemodialysis</topic><topic>Hepacivirus - genetics</topic><topic>Hepatitis</topic><topic>Hepatitis C</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - drug therapy</topic><topic>Hepatitis C, Chronic - virology</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Nephrology</topic><topic>Nephrology - Original Paper</topic><topic>Pilot Projects</topic><topic>Prospective Studies</topic><topic>Renal Insufficiency, Chronic - complications</topic><topic>Ribavirin</topic><topic>Risk factors</topic><topic>Ritonavir</topic><topic>Safety</topic><topic>Transplantation</topic><topic>Ultrasound</topic><topic>Urology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elmowafy, Ahmed Yahia</creatorcontrib><creatorcontrib>El Maghrabi, Hanzada Mohamed</creatorcontrib><creatorcontrib>Mashaly, Mohamed Elsayed</creatorcontrib><creatorcontrib>Eldahshan, Khaled Farouk</creatorcontrib><creatorcontrib>Rostaing, Lionel</creatorcontrib><creatorcontrib>Bakr, Mohamed Adel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elmowafy, Ahmed Yahia</au><au>El Maghrabi, Hanzada Mohamed</au><au>Mashaly, Mohamed Elsayed</au><au>Eldahshan, Khaled Farouk</au><au>Rostaing, Lionel</au><au>Bakr, Mohamed Adel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><addtitle>Int Urol Nephrol</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>51</volume><issue>12</issue><spage>2243</spage><epage>2254</epage><pages>2243-2254</pages><issn>0301-1623</issn><eissn>1573-2584</eissn><abstract>Background
Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.
Aim
The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.
Methods
Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.
Results
The patients’age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97);
p
= 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35);
p
= 0.001].
Conclusion
Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>31612423</pmid><doi>10.1007/s11255-019-02316-w</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-5130-7286</orcidid></addata></record> |
| fulltext | fulltext |
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| ispartof | International urology and nephrology, 2019-12, Vol.51 (12), p.2243-2254 |
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| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Acute Kidney Injury - epidemiology Acute Kidney Injury - etiology Adult Antiviral agents Antiviral Agents - therapeutic use Antiviral drugs Creatinine Female Genotype Genotypes Hemodialysis Hepacivirus - genetics Hepatitis Hepatitis C Hepatitis C, Chronic - complications Hepatitis C, Chronic - drug therapy Hepatitis C, Chronic - virology Humans Kidney diseases Male Medicine Medicine & Public Health Middle Aged Multivariate analysis Nephrology Nephrology - Original Paper Pilot Projects Prospective Studies Renal Insufficiency, Chronic - complications Ribavirin Risk factors Ritonavir Safety Transplantation Ultrasound Urology |
| title | High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents |
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