Hepatitis C in Dialysed Patients – What Is the Current Optimal Treatment?

Abstract

Hepatitis C virus (HCV) infection is an important cause of morbidity and mortality in the dialysis population. The problem is more pronounced after renal transplantation. It seems that immunosuppressive drugs facilitate HCV replication and accelerate hepatic lesions. Interferon is not recommended after renal transplantation because of the risk of acute rejection and graft dysfunction, and for this reason it is important to eradicate HCV RNA before transplantation. Prevention is the most important treatment measure. Good clinical practice together with screening of blood products and organs is of outstanding importance. Pegylated interferon (PEG-INF) and ribavirin are currently considered to be optimal therapy for HCV infection. Pegylation delays clearance of interferon, which leads to a more potent and longer antiviral effect. The two PEG-INF formulations (alfa-2a and alfa-2b) with different pharmacokinetic characteristics are currently available. Their clearance is reduced by almost 45% in patients with end-stage renal disease. Taken together with the high prevalence of adverse effects associated with the PEG-INF, an increased awareness of their use in dialysis patients is reasonable. There are few published studies on interferon and PEG-INF therapy in uremic patients. These studies confirm that the rate of response to different interferon formulations in dialysis is much higher than in the general population, but with a higher rate of adverse events. Ribavirin increases the response rate to treatment with PEG-INF. Great caution is warranted on its use in dialysis patients, whereas in patients with renal disease it accumulates and causes a dose-related haemolysis. Current results are encouraging but limited by a small number of patients and short follow-up. Multi-centre, controlled studies with longer follow-up are needed to establish an optimal protocol for the treatment of chronic HCV infection in dialysis patients.

Utility of routine real time quantitative PCR monitoring of HCV infection in haemodialysis patients

“…There is an urgency to treat the infection while on HD prior to transplant as immunosuppressive drugs used after renal transplant can enhance HCV replication and accelerate hepatic disease. [20] Earlier clinical and therapeutic trials have shown that patients with baseline HCV RNA level of more than 8 × 10 5 IU/ml had 9% lower sustained virological response rate as compared to those with a viral load of less than 8 × 10 5 IU/ml. [7] It is also important to note that patients with low HCV RNA levels have 15-39% better response to therapy than those with high RNA levels.…”

Pegylated Interferon for Treatment of Chronic Hepatitis C in Hemodialysis Patients in Croatia

“…Liver disease caused by hepatitis C virus (HCV) causes significant morbidity and mortality among patients with end-stage renal disease (ESRD) [1,2] . The disease is considered as slowly progressive in dialysis patients, but the major problem with HCV infection occurs after renal transplantation.…”

“…Standard treatment for HCV patients with normal renal function is a combination of PEG-IFN-␣ and ribavirin [1] . Ribavirin is a nucleoside analog with antiviral activity [7,8] .…”

Pegylated interferon alpha-2a monotherapy in a peritoneal dialysis patient with chronic hepatitis C

“…However, few case reports are available regarding the treatment of HCV infection in peritoneal dialysis (PD) patients, and moreover treatment protocol for PEG-IFN including the dose and timing of administration during PD has not been determined. In addition, adverse events after PEG-IFN therapy are shown to be more common and severe in dialysis patients, probably due to an enhanced half-life caused by renal dysfunction [ 3 ]. Thus, it is crucial to know the treatment protocol for HCV infection observed in PD patients that may provide a maximal therapeutic effect with minimal adverse events and also may not affect residual renal function.…”