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Hepatitis C virus and kidney disease.
Paul Martin1, Fabrizio Fabrizi
1Center for Liver Diseases, Miller School of Medicine, Department of Medicine, University of Miami, Miami, FL 33136, USA. PMartin2@med.miami.edu
Journal of Hepatology
|July 30, 2008
Summary
Hepatitis C virus (HCV) impacts patients on dialysis and kidney transplants. Antiviral therapy shows promise for acute HCV in dialysis patients and may benefit transplant candidates, but interferon is contraindicated post-transplant.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection is common in patients undergoing renal replacement therapy, negatively affecting survival in hemodialysis patients and kidney transplant recipients.
- HCV contributes to renal dysfunction, including chronic kidney disease and impaired renal allograft function, often through cryoglobulinemia.
- Nosocomial transmission of HCV persists within dialysis facilities.
Purpose of the Study:
- To review the current understanding of Hepatitis C virus in patients with renal failure.
- To evaluate the efficacy and safety of antiviral therapies for chronic and acute HCV in dialysis patients.
- To assess the implications of antiviral therapy for kidney transplant candidates and recipients.
Main Methods:
- Literature review of studies on HCV in renal failure patients.
- Analysis of data on interferon-based therapies (conventional, pegylated, and combination) for chronic and acute HCV.
- Evaluation of outcomes in dialysis patients and kidney transplant recipients.
Main Results:
- Conventional interferon monotherapy may be effective but less tolerated in dialysis patients compared to non-uraemic patients.
- Limited data exist for pegylated interferon and combination therapy in dialysis patients.
- Antiviral therapy for acute HCV in dialysis patients shows encouraging results.
- Interferon is contraindicated post-kidney transplant due to risks of graft dysfunction.
- Sustained viral responses in transplant candidates are durable post-transplant and may reduce complications.
Conclusions:
- Antiviral therapy for Hepatitis C in renal failure patients requires further investigation, particularly for pegylated interferon and combination regimens.
- While interferon is contraindicated post-kidney transplant, pre-transplant antiviral therapy can lead to durable responses and reduced post-transplant complications.
- Managing HCV in dialysis and transplant populations remains critical for improving patient outcomes.
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