Treatment of chronic hepatitis C infection in patients with renal failure

Patients with end-stage renal disease continue to have a high prevalence of hepatitis C virus infection despite screening of blood products and efforts to prevent the transmission of viral hepatitis within dialysis units. Although biochemical dysfunction often is absent in infected patients, an increased rate of mortality from liver disease has been observed in patients on long-term dialysis. In addition, hepatitis C-infected renal transplant recipients have diminished patient and graft survival rates compared with uninfected controls. Antiviral therapy with interferon in renal transplantation candidates has resulted in sustained viral responses that have been durable even after subsequent renal transplantation. Graft dysfunction remains a major concern, limiting the use of interferon after renal transplant. Ribavirin, which accumulates and cannot be removed by dialysis, and may induce hemolysis, generally has been avoided in patients with end-stage renal disease. In pilot studies, cautious use of reduced doses of ribavirin has been possible in this population with close monitoring of hematocrit levels and additional measures to enhance compensatory erythropoiesis.