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- Title
Management of HCV infection in chronic kidney disease.
- Authors
Rabih, S. Aoufi; Agudo, R. García
- Abstract
The prevalence of chronic infection with the hepatitis C virus (HCV) in patients with chronic kidney disease is higher than in the general population. The estimated prevalence is 13% in haemodialysis, with wide variations geographically and between units in the same country. A liver biopsy is a useful tool for deciding whether to start antiviral therapy and to exclude concomitant causes of liver dysfunction. Examples of this include nonalcoholic fatty liver disease, whose incidence is on the rise, and haemosiderosis, which may affect the progression of the disease and condition the response to antiviral therapy. In addition, the transjugular route can be used to measure the hepatic venous pressure gradient and confirm the existence of portal hypertension. Chronic hepatitis due to HCV has been shown to reduce survival in haemodialysis, renal transplantation and graft survival. It is the fourth leading cause of death and the leading cause of post-renal transplantation liver dysfunction. HCV behaves as an independent risk factor for the occurrence of proteinuria; it increases the risk of developing diabetes, de novo glomerulonephritis and chronic allograft nephropathy; it leads to a deterioration in liver disease and causes a greater number of infections. An increased frequency of fibrosing cholestatic hepatitis has also been described which, together with the rapid evolution to cirrhosis, can significantly increase morbidity and mortality and lead to the need for liver transplantation. In addition, immunosuppression in renal transplantation predisposes a reactivation of HCV. However, as the pharmacokinetics of interferon and ribavirin is impaired in kidney failure and their use has adverse effects on function and graft survival, a combination therapy is limited to non-transplanted individuals with an estimated glomerular filtration rate greater than 50 ml/min, and with the interferon being used as monotherapy in dialysis. The fact that a quarter of HCVpositive patients evaluated for a renal transplant have bridging fibrosis or cirrhosis in the liver biopsy may renew renal pre-transplant treatment planning.
- Subjects
HEPATITIS C prevention; CHRONIC kidney failure; KIDNEY transplantation; HEMODIALYSIS complications; BIOPSY; INTERFERONS; RIBAVIRIN; ANTIVIRAL agents; PREVENTION
- Publication
Nefrologia, 2011, Vol 31, Issue 3, p260
- ISSN
0211-6995
- Publication type
Article
- DOI
10.3265/Nefrologia.pre2011.Jan.10768