Treatment of HCV in Patients with Renal Failure

Diagnosis, management, and treatment of hepatitis C: An update

“…There have been numerous, mostly small, studies of treatment of patients with HCV infection who are on hemodialysis (CKD stage 5D) 283–299. These have included monotherapy with standard interferons285–290 leading to overall SVR rates of 33% to 37% with rates of 26% to 31% in persons with genotype 1 infection285, 286 but associated with high dropout rates 285, 288. Of note is that these SVR rates are higher than occurs in persons without kidney disease treated with standard interferon alone.…”

“…Of note is that these SVR rates are higher than occurs in persons without kidney disease treated with standard interferon alone. Higher response rates have been reported in hemodialysis patients treated with standard interferon and reduced doses of ribavirin,283, 289–291 with peginterferon alone,292–296 or peginterferon together with ribavirin,283, 297 but these have been associated with very high frequencies of side effects, requiring growth factors to treat the anemia and neutropenia, high dropout rates, and high rates of relapse on completion of treatment 283, 289–291. Clearly, treatment of patients on hemodialysis is fraught with difficult and requires meticulous attention to side effect management.…”

Treatment Considerations for Unique Patient Populations With HCV Genotype 1 Infection

“…99 According to the AASLD/IDSA guidelines, the majority of the clinical trials for first-line agents reported baseline BMI and the patients average weight. 76,77,[84][85][86][87][88][89][90][91][92] Several landmark clinical trials even reported results according to weight as a subgroup analysis, generally grouping results by BMI <30 and >30 kg/m 2 . 62,77,85 Based on the results from clinical trials published to date, obesity does not appear to have a significant impact on treatment response to DAAs.…”

Managing chronic hepatitis C in the difficult‐to‐treat patient

“…IFN monotherapy is the treatment of choice in HCV‐positive dialysis patients awaiting transplantation (92, 93); data are limited on peg‐IFN in dialysis patients (94–97). In addition, RBV is generally avoided in dialysis patients, because it may induce haemolytic anaemia (98). Two meta‐analyses found that IFN monotherapy produced SVR rates of 33–39% (92, 99).…”