Treatment of chronic hepatitis C in hemodialysis patients

[Guest guest]

12: Hepatology. 2008 Nov;48(5):1690-9.

Treatment of chronic hepatitis C in hemodialysis patients.

Berenguer M.

Hepatogastroenterology Service, Hospital La Fe, Facultad de Medicina de la

Universidad de Valencia, Valencia, Spain. mbhaym@...

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.

PMID: 18972442 [PubMed - in process]

[Guest guest]

12: Hepatology. 2008 Nov;48(5):1690-9.

Treatment of chronic hepatitis C in hemodialysis patients.

Berenguer M.

Hepatogastroenterology Service, Hospital La Fe, Facultad de Medicina de la

Universidad de Valencia, Valencia, Spain. mbhaym@...

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.

PMID: 18972442 [PubMed - in process]

[Guest guest]

12: Hepatology. 2008 Nov;48(5):1690-9.

Treatment of chronic hepatitis C in hemodialysis patients.

Berenguer M.

Hepatogastroenterology Service, Hospital La Fe, Facultad de Medicina de la

Universidad de Valencia, Valencia, Spain. mbhaym@...

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.

PMID: 18972442 [PubMed - in process]

[Guest guest]

12: Hepatology. 2008 Nov;48(5):1690-9.

Treatment of chronic hepatitis C in hemodialysis patients.

Berenguer M.

Hepatogastroenterology Service, Hospital La Fe, Facultad de Medicina de la

Universidad de Valencia, Valencia, Spain. mbhaym@...

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.

PMID: 18972442 [PubMed - in process]