Hepatitis C virus (HCV)
infection is especially problematic in patients with
end-stage renal disease (
ESRD) who are undergoing
hemodialysis. Rates of HCV
infection are higher among
hemodialysis patients than in the general population, and several routes of transmission are thought to stem from the dialysis unit. Management of chronic
hepatitis C is also more complicated in
hemodialysis patients because of altered pharmacokinetics and a predisposition for
drug-related toxicity, particularly
ribavirin-induced
anemia. Clinical trials of patients with
chronic hepatitis C and healthy, functioning kidney grafts are rare because of the inherent dangers of graft rejection. As a result, most studies in patients with
ESRD have focused on patients waiting for a kidney transplant. Additionally, because
ribavirin is contraindicated in this patient population, many studies have examined monotherapy treatments. According to meta-analyses, conventional
interferon alfa treatment yields a sustained virological response (SVR) rate of 37%, whereas studies of pegylated
interferon alfa monotherapy have yielded SVR rates between 13% and 75%. Several small studies have also used the monitoring of
ribavirin plasma concentrations or
hemoglobin levels to facilitate the use of combination
therapy. In light of the results from these clinical trials, we herein review treatment guidelines and recommend strategies to help optimize the treatment of patients with
ESRD.
CONCLUSION: There remains a lack of clarity surrounding the most effective treatment options for patients with
chronic hepatitis C and
ESRD. Treatment can be effective with many patients attaining SVR; however, unfavorable tolerability with
interferon alfa-based
therapy remains a concern and thus close supportive care should be aggressively pursued to help maintain adherence.