Management of HCV infection in chronic kidney disease

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Buset Ríos, Francisco Rodríguez Esparragón, F. Rodríguez Esparragón, Carlos Fernández-Andrade Rodríguez, C. Fernández-Andrade Rodríguez, José Carlos Rodríguez Pérez, J.C. Rodríguez Pérez" "autores" => array:9 [ 0 => null 1 => array:2 [ "nombre" => "Nisa" "apellidos" => "Buset Ríos" ] 2 => array:2 [ "Iniciales" => "N." "apellidos" => "Buset Ríos" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "Rodríguez Esparragón" ] 4 => array:2 [ "Iniciales" => "F." "apellidos" => "Rodríguez Esparragón" ] 5 => array:2 [ "nombre" => "Carlos" "apellidos" => "Fernández-Andrade Rodríguez" ] 6 => array:2 [ "Iniciales" => "C." "apellidos" => "Fernández-Andrade Rodríguez" ] 7 => array:2 [ "nombre" => "José Carlos" "apellidos" => "Rodríguez Pérez" ] 8 => array:2 [ "Iniciales" => "J.C." 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A pressing need" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "256" "paginaFinal" => "259" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Conocer y controlar los costes del tratamiento de la insuficiencia renal crónica. Una necesidad inaplazable" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Martín Hernández" "autores" => array:1 [ 0 => array:2 [ "Iniciales" => "R." "apellidos" => "Martín Hernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511052047" "doi" => "10.3265/Nefrologia.pre2011.May.10959" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052047?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052044?idApp=UINPBA000064" "url" => "/20132514/0000003100000003/v0_201502091638/X2013251411052044/v0_201502091638/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Management of HCV infection in chronic kidney disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "260" "paginaFinal" => "267" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "S. Aoufi Rabih, R. García Agudo" "autores" => array:2 [ 0 => array:3 [ "Iniciales" => "S." "apellidos" => "Aoufi Rabih" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "affa" ] ] ] 1 => array:4 [ "Iniciales" => "R." "apellidos" => "García Agudo" "email" => array:1 [ 0 => "rgarciaagudo@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, " "etiqueta" => "a" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Servicio de Nefrología, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, " "etiqueta" => "b" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manejo de la infección por el VHC en la enfermedad renal crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10768_16025_14629_en_t1__10768.jpg" "Alto" => 292 "Ancho" => 600 "Tamanyo" => 97787 ] ] "descripcion" => array:1 [ "en" => "Prevalence of HCV infection in haemodialysis" ] ] ] "textoCompleto" => "INTRODUCTION The World Health Organisation estimates the global prevalence of chronic infection with the hepatitis C virus (HCV) to be 3%, with wide geographic variation: less than 5% in most Northern European countries, about 10% in southern Europe and the United States, and between 10%-50% and up to 70% in many developing countries, including parts of Asia, Latin America and North Africa. The incidence of HCV infection has been reduced to less than 1%-2% in developed countries.1-3 HCV infection in patients with stage 5 chronic kidney disease (CKD) is higher than in the general population. In haemodialysis patients, there is a prevalence of 13%, with a range of 1%-70%4 (Table 1). Furthermore, the prevalence of HCV is highly variable among haemodialysis units within the same country.5 In Spain, the prevalence of HCV infection in haemodialysis in 1997-2001 was estimated at 22%.4 In renal transplant patients, the prevalence of HCV infection ranges between 7% and 40%, also with a wide geographic and demographic variation.4,17-19 Up to 55%-85% of those infected with HCV progress to the chronic stage,20-23 and 5%-25% of these develop cirrhosis at 25-30 years.20,24 Individuals with cirrhosis have a higher risk of hepatocellular carcinoma than the non-cirrhotic population. In Spain, HCV is currently the main risk factor associated with hepatocellular carcinoma,25 although the risk varies with the extent to which the liver is affected. It is less than 1% annually in patients with chronic hepatitis without significant fibrosis, and reaches 3%-7% annually for cirrosis.26 Once liver cirrhosis is found, there is a risk of liver hepatocellular carcinoma continuing to develop, despite having a sustained viral response to treatment.27 Several factors for progression to cirrhosis have been identified: advanced age, obesity, immunosuppression, alcohol consumption greater than 50g/day,28-31 and a more rapid evolution to cirrhosis has been described in renal transplant patients.32-34 LIVER HISTOLOGY: ROLE OF BIOPSY A liver biopsy is of substantial value in assessing the severity of liver disease in chronic HCV infection, in relation to the degree of fibrosis and necroinflammatory activity, as well as for excluding other concomitant causes of liver dysfunction. These include non-alcoholic fatty liver disease, whose incidence is on the rise, and haemosiderosis, which may affect the progression of the disease and determine the response to treatment.35-38 The KDIGO guides (Kidney Disease Improving Global Outcomes)39 recommend a liver biopsy in the liver disease study of patients eligible for renal transplantation. The AASLD guide (American Association for the Study of Liver Diseases) limits it to HCV-positive patients with genotypes 1 and 4, but considers it unnecessary in genotypes 2 and 3,40 given that over 80% of patients (with normal renal function) achieve a sustained viral response. The METAVIR score evaluates necroinflammatory activity (grade) and fibrosis (stage). It consists of a coding system of two letters and two numbers: A= histological activity (A0= no activity, A1= mild activity, A2= moderate activity, A3= severe activity); and F= fibrosis (F0= no fibrosis, F1= portal fibrosis without septa, F2= portal fibrosis with few septa, F3= numerous septa without fibrosis, F4= fibrosis).41 It requires a high quality liver biopsy of at least 2cm in length, with more than 5 portal tracts, to calculate an appropriate METAVIR score.42,43 According to the KDIGO guidelines, patients on the waiting list for a kidney transplant who do not respond to or refuse antiviral treatment must undergo a liver biopsy every 3-5 years, depending on the initial METAVIR score (every 3 years for a METAVIR score of 3, and every 5 years for a METAVIR score of 1-2).39 There is no evidence to support this recommendation, although it has been shown that liver disease progresses in patients on dialysis.17,34 Liver damage markers like GPT do not accurately reflect the histological severity of liver disease of CKD patients, and up to 25% of patients with HCV infection evaluated for renal transplantation have bridging fibrosis or cirrhosis in the liver biopsy (METAVIR>3).44-49 No definitive studies have investigated whether the histological stage of the pre-transplant biopsy predicts post-transplant liver disease and its outcomes. However, the presence of cirrhosis in the pre-transplant liver biopsy has been associated with a 26% survival at 10 years.50 Several studies have shown that 19%-64% of renal transplant patients infected with HCV have post-transplant liver disease, compared with only 1%-30% of patients not infected.18,50-56 Most studies are retrospective, with patients without a pre-transplant liver biopsy. This could result in an underestimation of advanced liver disease, given the increase in the rate of decompensated liver disease. Studies without a pre-transplant liver biopsy, but with a post-transplant sequential liver biopsy, have shown that liver histology may progress in 20% of patients.57,58 Since there is a 6%-8% annual mortality risk in patients on a transplant waiting list,59 it seems reasonable to monitor their liver disease to check if a renal transplant is still appropriate for their condition. Liver damage before renal transplantation is an independent predictor of poor long-term survival.50 Coagulopathy secondary to hepatocellular dysfunction and thrombocytopaenia due to portal hypertension and hypersplenism poses an increased risk of bleeding.60 Due to the presence of ascites in CKD patients, and because of the added risk of increased bleeding from platelet dysfunction associated with uraemia, haemodialysis anticoagulation and antiplatelet therapy, a liver biopsy via the transjugular or transfemoral route is often recommended. This can provide additional diagnostic information, such as the hepatic venous pressure gradient, to confirm the existence of portal hypertension.39,40 Desmopressin (DDAVP, 0.3mg/kg) has been used more often immediately before liver biopsy in CKD patients. However, we were not able to find defined serum creatinine level or glomerular filtration rates which should be used for desmopressin indication.61  The utility of non-invasive markers (Index of Forns, APRI or FIB-4) in the study of liver damage in patients with CKD and HCV infection is not known at present.62 There were hopes for transient elastography (FibroScan), which has failed to replace the biopsy: it has not been approved by the FDA (Food and Drug Administration), the error rate is higher in obese patients and may be overestimated in acute hepatitis, which is associated with high necroinflammatory activity and low or nil fibrosis.63,64 TREATMENT The treatment of choice for chronic HCV hepatitis is conventional or pegylated interferon, alone or in combination with ribavirin. The antiviral treatment should be individualised, depending on the severity of the liver disease, the possibility of serious adverse effects, variability in the response to treatment, the presence of comorbidity (particularly renal failure) and the patient's decision.40 Individuals with CKD have lower to normal levels of transaminases45,65-67 compared to those without CKD. Traditionally, it was considered that subjects with genotype 1 and persistently normal transaminases had minimal hepatic fibrosis and were thus not appropriate for treatment. Today, it has been shown that up to 25% of these patients have significant fibrosis, and that their response to treatment is similar to patients with elevated transaminases.68-74 Patients with extrahepatic manifestations have to be treated, regardless of the severity of the liver disease.75 In individuals with normal renal function, antiviral therapy is aimed at eradicating HCV infection to improve liver histology, which in the long term results in lower morbidity and improved survival. In patients with CKD, the treatment of HCV is even more relevant, because chronic hepatitis has been shown to reduce survival in haemodialysis, renal transplantation and renal graft survival,18,50-56,76-78 compared with non-infected patients. This is partly due to the progression of liver disease, the rapid evolution to cirrhosis and/or appearance of hepatocellular carcinoma.18,32-34,50,56,79 HCV infection is the leading cause of renal post-transplant liver dysfunction and the fourth cause of mortality in this group.33 HCV behaves as an independent risk factor for the occurrence of proteinuria,53,80 it increases the risk of developing diabetes after transplantation,81-83 de novo glomerulonephritis,84-87 and chronic allograft nephropathy, and worsens liver disease and causes more infections.39 In addition, immunosuppression in renal transplantation enhances HCV reactivation. In particular, steroids have been associated with a 10 to 100 fold increase in the viral load.88 They should therefore be avoided or minimised in HCV-positive patients.89 In addition, an increased frequency of fibrosing cholestatic hepatitis has been described which, together with the rapid evolution to cirrhosis, may significantly increase morbidity and mortality, leading to the need for a liver transplant.90,91 However, antiviral therapy in CKD remains controversial. There are no comparative studies to support the decision of an appropriate antiviral treatment. Most haemodialysis studies have investigated the use of conventional alpha interferon (3MIU 3 times a week) or pegylated alpha interferon (alpha 2a, 135µg/week; or alpha 2b, 50µg/week, or 0.5-1µg/kg/week) in monotherapy. The results are different but, generally, there is a low sustained viral response (19%-75%) and significant drug intolerance (30%-50% of dialysis patients interrupt the therapy).92-95 The American Gastroenterological Association (AGA) and the AASLD recommend the use of reduced doses of pegylated alpha interferon in monotherapy, and consider the association of ribavirin as a contraindication in patients with an estimated glomerular filtration rate less than 50ml/min.40,96,97-104 There is little experience with the ribavirin combination therapy (200mg, 3 times a week or 200mg/24h) in dialysis. Better results have been suggested, although the studies were for few case series with a very limited number of patients.105-110 A recent meta-analysis of existing clinical trials on combination therapy in dialysis showed that about half of the patients obtained a sustained viral response.111 The risk of severe anaemia due to secondary haemolysis makes it difficult to use, although some researchers have used it based on serum drug levels, obtaining uneven results.106-110,112 Available data, however, are encouraging and its use may be indicated in centres where patient are treated by hepatologists and nephrologists. Antiviral treatment in renal transplant recipients is rare except in cases with limited therapeutic alternatives or severe cholestatic hepatitis.90,91 The main drawback of antiviral treatment before transplantation is the delayed inclusion of the patient on the waiting list, without being able to ensure HCV eradication due to the low response figures. Therefore, all haemodialysis patients with detectable HCV RNA and an F0-F2 METAVIR score should be considered as candidates for treatment with alpha interferon. The bridging fibrosis patients with compensated cirrhosis should also receive antiviral therapy, and be eventual candidates for renal transplantation if they achieve a sustained viral response. Patients with decompensated cirrhosis should be evaluated for a combined kidney and liver transplant.40 In light of the impact of chronic HCV infection in renal transplantation, it is recommended that patients with CKD are treated prior to undergoing the transplant.113,114 However, despite the evidence on the benefits of antiviral treatment in patients with chronic HCV infection and CKD prior to renal transplantation, only a few kidney transplant protocols recommend treatment against HCV, and it is not usually listed as a pre-transplant criterion.115-117 In fact, the evaluation before a kidney transplant for HCV-positive patients on renal replacement therapy shows that, as well as not considering treatment for HCV before transplantation, hepatology monitoring of these patients on dialysis is virtually nonexistent in many cases. This may be due to the inherent complexity of CKD treatment, leading the nephrologist to assume all the patient pathology in haemodialysis. Further studies are needed to assess the clinical situation and monitoring of HCV hepatitis in patients on haemodialysis, to identify improvements and involve both nephrologists and hepatologists in its management.<a href="grande/10768_16025_14629_en_t1__10768.jpg" class="elsevierStyleCrossRefs"><img src="10768_16025_14629_en_t1__10768.jpg" alt="Prevalence of HCV infection in haemodialysis"></img></a>Table 1. Prevalence of HCV infection in haemodialysis" "pdfFichero" => "P1-E521-S2953-A10768-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:7 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441047" "palabras" => array:1 [ 0 => "Virus de la hepatitis C" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441049" "palabras" => array:1 [ 0 => "Enfermedad renal crónica" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441051" "palabras" => array:1 [ 0 => "Ribavirina" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441053" "palabras" => array:1 [ 0 => "Interferón" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441055" "palabras" => array:1 [ 0 => "Trasplante renal" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441057" "palabras" => array:1 [ 0 => "Biopsia hepática" ] ] 6 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec441059" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] ] "en" => array:7 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441048" "palabras" => array:1 [ 0 => "Hepatitis C virus" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441050" "palabras" => array:1 [ 0 => "Chronic kidney disease" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441052" "palabras" => array:1 [ 0 => "Ribavirin" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441054" "palabras" => array:1 [ 0 => "Interferon" ] ] 4 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441056" "palabras" => array:1 [ 0 => "Renal transplantation" ] ] 5 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441058" "palabras" => array:1 [ 0 => "Liver biopsy" ] ] 6 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441060" "palabras" => array:1 [ 0 => "Hemodialysis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "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 non-alcoholic fatty liver disease, whose incidence is on the rise, and haemosiderosis, which may affect the progression of the disease and determine the response to antiviral therapy. In addition, the transjugular approach 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 mellitus, 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 must be limited to non-transplanted individuals with an estimated glomerular filtration rate greater than 50ml/min, and with the interferon being used as monotherapy in dialysis. The fact that a quarter of HCV-positive patients evaluated for a renal transplant have bridging fibrosis or cirrhosis in the liver biopsy may renew renal pre-transplant treatment planning." ] "es" => array:1 [ "resumen" => "La prevalencia de la infección crónica por el virus de la hepatitis C (VHC) en pacientes con enfermedad renal crónica es mayor que en la población general. En hemodiálisis, se estima una prevalencia del 13%, con una amplia variabilidad geográfica y entre las unidades de un mismo país. La biopsia hepática es una herramienta útil para decidir el inicio de la terapia antiviral y excluir causas concomitantes de disfunción hepática, como la hepatopatía grasa no alcohólica, cuya incidencia está en auge, y la hemosiderosis, que pueden afectar a la progresión de la enfermedad y condicionar la respuesta al tratamiento antiviral; además, la vía transyugular se puede utilizar para medir el gradiente de presión venoso hepático y confirmar la existencia de hipertensión portal. La hepatitis crónica por el VHC ha demostrado reducir la supervivencia en hemodiálisis y en el trasplante renal, así como la supervivencia del injerto. Constituye la cuarta causa de mortalidad y la principal causa de disfunción hepática postrasplante renal. El VHC se comporta como un factor de riesgo independiente para la aparición de proteinuria, aumenta el riesgo de desarrollar diabetes, una glomerulonefritis de novo o una nefropatía crónica del injerto, de empeorar la enfermedad hepática y de provocar un mayor número de infecciones. También se ha descrito un incremento de la frecuencia de hepatitis colestásica fibrosante que, junto a la evolución acelerada a cirrosis, puede elevar significativamente la morbimortalidad y conllevar la necesidad de un trasplante hepático. Además, la inmunosupresión en el trasplante renal predispone a la reactivación del VHC. Sin embargo, como la farmacocinética del interferón y la ribavirina está alterada en la insuficiencia renal y su uso tiene efectos adversos sobre la función y la supervivencia del injerto, la terapia combinada se limita a los individuos no trasplantados con un filtrado glomerular estimado mayor de 50 ml/min y en diálisis suele emplearse el interferón en monoterapia. El hecho de que una cuarta parte de los pacientes VHC-positivos evaluados para trasplante renal tenga fibrosis en puente o cirrosis en la biopsia hepática puede renovar el planteamiento del tratamiento pretrasplante renal." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10768_16025_14629_en_t1__10768.jpg" "Alto" => 292 "Ancho" => 600 "Tamanyo" => 97787 ] ] "descripcion" => array:1 [ "en" => "Prevalence of HCV infection in haemodialysis" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:118 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "\u{A0}" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysisassociated diseases in the United States, 2002. Semin Dial 2005;18(1):52-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15663766" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Espinosa M, Martín-Malo A, Ojeda R, Santamara R, Soriano S, Aguera M, et al. Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J Kidney Dis 2004;43(4):685-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15042545" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jadoul M, Poignet JL, Geddes C, Locatelli F, Medin C, Krajewska M, et al. The changing epidemiology of hepatitis C virus (HCV) infection in haemodialysis: European multicentre study. Nephrol Dial Transplant 2004;19(4):904-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15031348" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fissell RB, Bragg-Gresaham JL, Woods JD, Jadoul M, Gillespie B, Hedderwick SA, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65(6):2335-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15149347" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sivapalasingam S, Malak SF, Sullivan JF, Lorch J, Sepkowitz KA. High prevalence of hepatitis C infection among patients receiving hemodialysis at an urban dialysis center. Infect Control Hosp Epidemiol 2002;23(6):319-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12083235" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hinrichsen H, Leimenstoll G, Stegen G, Schrader H, Fölsch UR, Schmidt WE; PHV Study Group. Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients. Gut 2002;51(3):429-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12171969" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Huraib S, Al-Rashed R, Aldrees A, Aljefry M, Arif M, Al-Faleh FA. High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies. Nephrol Dial Transplant 1995;10(4):470-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7623989" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Santos MA, Souto FJ. Infection by the hepatitis C virus in chronic renal failure patients undergoing hemodialysis in Mato Grosso state, central Brazil: a cohort study. BMC Public Health 2007;7:32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17352803" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Saha D, Agarwal SK. Hepatitis and HIV infection during haemodialysis. J Indian Med Assoc 2001;99(4):194-9." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "10.\u{A0} Shamshirsaz AA, Kamgar M, Bekheirnia MR, Ayazi F, Hashemi SR, Bouzari N, et al. The role of hemodialysis machines dedication in reducing Hepatitis C transmission in the dialysis setting in Iran: a multicenter prospective interventional study. BMC Nephrol 2004;5(1):13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15469615" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Blackmore TK, Stace NH, Maddocks P, Hatfield P. Prevalence of antibodies to hepatitis C virus in patients receiving renal replacement therapy, and in the staff caring for them. Aust N Z J Med 1992;22(4):353-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1280095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Schneeberger PM, Keur I, Van Loon AM, Mortier D, De Coul KO, Van Haperen AV, et al. The prevalence and incidence of hepatitis C virus infections among dialysis patients in the Netherlands: a nationwide prospective study. J Infect Dis 2000;182(5):1291-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11023452" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hruby Z, Sliwinski J, Molin I, Zalewska M, Knysz B, Czyz W, et al. High prevalence of antibodies to hepatitis C virus in three haemodialysis centres in south-western Poland. Nephrol Dial Transplant 1993;8(8):740-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7692355" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cassidy MJ, Jankelson D, Becker M, Dunne T, Walzl G, Moosa MR. The prevalence of antibodies to hepatitis C virus at two haemodialysis units in South Africa. S Afr Med J 1995;85(10):996-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8596992" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Luengrojanakul P, Vareesangthip K, Chainuvati T, Murata K, Tsuda F, Tokita H, et al. Hepatitis C virus infection in patients with chronic liver disease or chronic renal failure and blood donors in Thailand. J Med Virol 1994;44(3):287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7531758" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hmaied F, Ben Mamou M, Saune-Sandres K, Rostaing L, Slim A, Arrouji Z, et al. Hepatitis C virus infection among dialysis patients in Tunisia: incidence and molecular evidence for nosocomial transmission. J Med Virol 2006;78(2):185-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16372289" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pereira BJ, Natov SN, Bouthot BA, Murthy BV, Ruthazer R, Schmid CH, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1998;53(5):1374-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9573555" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hanafusa T, Ichikawa Y, Kishikawa H, Kyo M, Fukunishi T, Kokado Y, et al. Retrospective study on the impact of hepatitis C virus infection on kidney transplant patients over 20 years. Transplantation 1998;66(4):471-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9734490" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vosnides GG. Hepatitis C in renal transplantation. Kidney Int 1997;52(3):843-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9291208" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment and prevention of hepatitis C. Ann Intern Med 2000;132(4):296-305." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "21.\u{A0}Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis 2005;9(3):383-98." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Strader DB, Seeff LB. The natural history of chronic hepatitis C infection. Eur J Gastroenterol Hepatol 1996;8(4):324-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8781898" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Seeff LB, Hoofnagle JH. National Institutes of Health Consensus Development Conference: management of hepatitis C: 2002. Hepatology 2002;36(5 Suppl 1):S1-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12407571" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Seeff LB. Natural history of chronic hepatitis C. Hepatology 2002;36(5 Suppl 1):S35-S46." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Forner A, Ayuso C, Real MI, Sastre J, Robles R, Sangro B, et al. Diagnóstico y tratamiento del carcinoma hepatocelular. Med Clin (Barc) 2009;132(7):272-87." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: Incidente and risk factors. Gastroenterology 2004;127(5 Suppl 1):S35-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15508101" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bruno S, Stroffolini T, Colombo M, Bollani S, Benvegnu L, Mazzella G, et al. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: A retrospective study. Hepatology 2007;45(3):579-87. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17326216" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Benhamou Y, Bochet M, Di Martino V, Charlotte F, Azria F, Coutellier A, et al. Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group. Hepatology 1999;30(4):1054-8." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet 1997;349(9055):825-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9121257" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Harris DR, Gonin R, Alter HJ, Wright EC, Buskell ZJ, Hollinger FB, et al. The relationship of acute transfusion-associated hepatitis to the development of cirrhosis in the presence of alcohol abuse. Ann Intern Med 2001;134(2):120-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11177315" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Powell EE, Jonsson JR, Clouston AD. Steatosis: co-factor in other liver diseases. Hepatology 2005;42(1):5-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15962320" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 32 => array:3 [ "identificador" => "bib33" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Marcelli D, Stannard D, Conte F, Held PJ, Locatelli F, Port FK. ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. Kidney Int 1996;50(3):1013-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8872978" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 33 => array:3 [ "identificador" => "bib34" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 1999;354(9173):93-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10408483" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 34 => array:3 [ "identificador" => "bib35" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Nakayama E, Akiba T, Marumo F, Sato C. Prognosis of anti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy. J Am Soc Nephrol 2000;11(10):1896-902. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11004221" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 35 => array:3 [ "identificador" => "bib36" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kleiner DE. The liver biopsy in chronic hepatitis C: a view from the other side of the microscope. Semin Liver Dis 2005;25(1):52-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15731997" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 36 => array:3 [ "identificador" => "bib37" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rubbia-Brandt L, Fabris P, Paganin S, Leandro G, Male PJ, Giostra E, et al. Steatosis affects chronic hepatitis C progression in a genotype specific way. Gut 2004;53(3):406-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14960525" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 37 => array:3 [ "identificador" => "bib38" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Poynard T, Ratziu V, McHutchison J, Manns M, Goodman Z, Zeuzem S, et al. Effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology 2003;38(1):75-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12829989" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 38 => array:3 [ "identificador" => "bib39" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Olynyk JK, Reddy KR, Di Bisceglie AM, Jeffers LJ, Parker TI, Radick JL, et al. Hepatic iron concentration as a predictor of response to interferon alfa therapy in chronic hepatitis C. Gastroenterology 1995;108(4):1104-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7698578" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109706026581" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib40" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kidney Disease Improving Global Outcomes. Clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int 2008;73(Suppl 109):S53-S68." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 40 => array:3 [ "identificador" => "bib41" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009;49(4):1335-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19330875" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 41 => array:3 [ "identificador" => "bib42" "etiqueta" => "42" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numeral scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1(5):431-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7308988" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344(7):495-500. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11172192" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 43 => array:3 [ "identificador" => "bib44" "etiqueta" => "44" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97(10):2614-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12385448" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 44 => array:3 [ "identificador" => "bib45" "etiqueta" => "45" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Martin P, Carter D, Fabrizi F, Dixit V, Conrad AJ, Artinian L, et al. Histopathological features of hepatitis C in renal transplant candidates. Transplantation 2000;69(7):1479-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10798774" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109710037186" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 45 => array:3 [ "identificador" => "bib46" "etiqueta" => "46" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Caramelo C, Ortiz A, Aguilera B, Porres JC, Navas S, Marriott E, et al. Liver disease patterns in hemodialysis patients with antibodies to hepatitis C virus. Am J Kidney Dis 1993;22(6):822-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7504404" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 46 => array:3 [ "identificador" => "bib47" "etiqueta" => "47" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Cotler SJ, Diaz G, Gundlapalli S, Jakate S, Chawla A, Mital D, et al. Characteristics of hepatitis C in renal transplant candidates. J Clin Gastroenterol 2002;35(2):191-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12172367" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 47 => array:3 [ "identificador" => "bib48" "etiqueta" => "48" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Glicklich D, Thung SN, Kapoian T, Tellis V, Reinus JF. Comparison of clinical features and liver histology in hepatitis C-positive dialysis patients and renal transplant recipients. Am J Gastroenterol 1999;94(1):159-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9934748" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 48 => array:3 [ "identificador" => "bib49" "etiqueta" => "49" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pol S, Romeo R, Zins B, Driss F, Lebkiri B, Carnot F, et al. Hepatitis C virus RNA in anti-HCV positive hemodialyzed patients: significance and therapeutic implications. Kidney Int 1993;44(5):1097-100. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8264141" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 49 => array:3 [ "identificador" => "bib50" "etiqueta" => "50" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sterling RK, Sanyal AJ, Luketic VA, Stravitz RT, King AL, Post AB, et al. Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation. Am J Gastroenterol 1999;94(12):3576-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10606322" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 50 => array:3 [ "identificador" => "bib51" "etiqueta" => "51" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mathurin P, Mouquet C, Poynard T, Sylla C, Benalia H, Fretz C, et al. Impact of hepatitis B and C virus on kidney transplantation outcome. Hepatology 1999;29(1):257-63." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 51 => array:3 [ "identificador" => "bib52" "etiqueta" => "52" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Breitenfeldt MK, Rasenack J, Berthold H, Olschewski M, Schroff J, Strey C, et al. Impact of hepatitis B and C on graft loss and mortality of patients after kidney transplantation. Clin Transplant 2002;16(2):130-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11966783" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 52 => array:3 [ "identificador" => "bib53" "etiqueta" => "53" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bruchfeld A, Wilczek H, Elinder CG. Hepatitis C infection, time in renal replacement therapy, and outcome after kidney transplantation. Transplantation 2004;78(5):745-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15371680" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 53 => array:3 [ "identificador" => "bib54" "etiqueta" => "54" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Morales JM, Domínguez-Gil B, Sanz-Guajardo D, Fernández J, Escuin F. The influence of hepatitis B and hepatitis C virus infection in the recipient on late renal allograft failure. Nephrol Dial Transplant 2004;19(Suppl 3):iii72-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15192141" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 54 => array:3 [ "identificador" => "bib55" "etiqueta" => "55" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gentil MA, Rocha JL, Rodríguez-Algarra G, Pereira P, López R, Bernal G, et al. Impaired kidney transplant survival in patients with antibodies to hepatitis C virus. Nephrol Dial Transplant 1999;14(10):2455-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10528672" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 55 => array:3 [ "identificador" => "bib56" "etiqueta" => "56" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Legendre C, Garrigue V, Le Bihan C, Mamzer-Bruneel MF, Chaix ML, Landais P, et al. Harmful long-term impact of hepatitis C virus infection in kidney transplant recipients. Transplantation 1998;65(5):667-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9521201" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 56 => array:3 [ "identificador" => "bib57" "etiqueta" => "57" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Murthy BV, Muerhoff AS, Desai SM, Yamaguchi J, Mushahwar IK, Schmid CH, et al. Impact of pretransplantation GB virus C infection on the outcome of renal transplantation. J Am Soc Nephrol 1997;8(7):1164-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9219167" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 57 => array:3 [ "identificador" => "bib58" "etiqueta" => "58" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kamar N, Rostaing L, Selves J, Sandres-Saune K, Alric L, Durand D. Natural history of hepatitis C virus-related liver fibrosis after renal transplantation. Am J Transplant 2005;5(7):1704-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15943629" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 58 => array:3 [ "identificador" => "bib59" "etiqueta" => "59" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zylberberg H, Nalpas B, Carnot F, Skhiri H, Fontaine H, Legendre C, et al. Severe evolution of chronic hepatitis C in renal transplantation: a case control study. Nephrol Dial Transplant 2002;17(1):129-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11773476" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 59 => array:3 [ "identificador" => "bib60" "etiqueta" => "60" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, in, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 60 => array:3 [ "identificador" => "bib61" "etiqueta" => "61" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Caldwell SH, Hoffman M, Lisman T, Macik BG, Northup PG, Reddy KR, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assesment of current management. Hepatology 2006;44(4):1039-46. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17006940" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 61 => array:3 [ "identificador" => "bib62" "etiqueta" => "62" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "DiMichele DM, Hathaway WE. Use of DDAVP in inherited and acquired platelet dysfunction. Am J Hematol 1990;33(1):39-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2293761" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 62 => array:3 [ "identificador" => "bib63" "etiqueta" => "63" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Campbell MS, Reddy KR. Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther 2004;20(3):249-59. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15274661" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 63 => array:3 [ "identificador" => "bib64" "etiqueta" => "64" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology 2008;47(2):380-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18095306" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 64 => array:3 [ "identificador" => "bib65" "etiqueta" => "65" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sagir A, Erhardt A, Schmitt M, Häussinger D. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008;47(2):592-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18098325" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 65 => array:3 [ "identificador" => "bib66" "etiqueta" => "66" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Espinosa M, Martín-Malo A, Álvarez de Lara MA, Soriano S, Aljama P. High ALT levels predict viremia in anti-HCV-positive HD patients if a modified normal range of ALT is applied. Clin Nephrol 2000;54(2):151-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10968693" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 66 => array:3 [ "identificador" => "bib67" "etiqueta" => "67" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Guh JY, Lai YH, Yang CY, Chen SC, Chuang WL, Hsu TC, et al. Impact of decreased serum transaminase levels on the evaluation of viral hepatitis in hemodialysis patients. Nephron 1995;69(4):459-65. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7777113" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 67 => array:3 [ "identificador" => "bib68" "etiqueta" => "68" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fabrizi F, Lunghi G, Finazzi S, Colucci P, Pagano A, Ponticelli C, et al. Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis. Am J Kidney Dis 2001;38(5):1009-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11684554" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 68 => array:3 [ "identificador" => "bib69" "etiqueta" => "69" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Martinot-Peignoux M, Boyer N, Cazals-Hatem D, Pham BN, Gervais A, Le Breton V, et al. Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA. Hepatology 2001;34(5):1000-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11679971" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 69 => array:3 [ "identificador" => "bib70" "etiqueta" => "70" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Shiffman ML, Diago M, Tran A, Pockros P, Reindollar R, Prati D, et al. Chronic hepatitis C in patients with persistently normal alanine transaminase levels. Clin Gastroenterol Hepatol 2006;4(5):645-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16630770" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 70 => array:3 [ "identificador" => "bib71" "etiqueta" => "71" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Boccato S, Pistis R, Noventa F, Guido M, Benvegnù L, Alberti A. Fibrosis progression in initially mild chronic hepatitis C. J Viral Hepat 2006;13(5):297-302. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16637859" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 71 => array:3 [ "identificador" => "bib72" "etiqueta" => "72" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Persico M, Persico E, Suozzo R, Conte S, De Seta M, Coppola L, et al. Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels. Gastroenterology 2000;118(4):760-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10734027" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 72 => array:3 [ "identificador" => "bib73" "etiqueta" => "73" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yu ML, Dai CY, Lee LP, Hou NJ, Hsieh MY, Huang JF, et al. A 24-week course of high-dose interferon-alpha plus ribavirin for Taiwanese chronic hepatitis C patients with persistently normal or near-normal alanine aminotransferase levels. Liver Int 2006;26(10):1187-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17105583" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 73 => array:3 [ "identificador" => "bib74" "etiqueta" => "74" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jacobson IM, Ahmed F, Russo MW, Lebovics E, Dieterich DT, Esposito SP, et al. Interferon alfa-2b [correction of alpha-2b] and ribavirin for patients with chronic hepatitis C and normal ALT. Am J Gastroenterol 2004;99(9):1700-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15330905" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 74 => array:3 [ "identificador" => "bib75" "etiqueta" => "75" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Zeuzem S, Diago M, Gane E, Reddy KR, Pockros P, Prati D, et al. Peginterferon alfa-2a (40 kilodaltons) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology 2004;127(6):1724-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15578510" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 75 => array:3 [ "identificador" => "bib76" "etiqueta" => "76" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yee HS, Curie SL, Darling JM, Wright TL. Management and treatment of hepatitis C viral infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office. Am J Gastroenterol 2006;101(10):2360-78. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17032203" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 76 => array:3 [ "identificador" => "bib77" "etiqueta" => "77" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lee WC, Shu KH, Cheng CH, Wu MJ, Chen CH, Lian JC. Long-term impact of hepatitis B, C virus infection on renal transplantation. Am J Nephrol 2001;21 (4):300-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11509802" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 77 => array:3 [ "identificador" => "bib78" "etiqueta" => "78" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Aroldi A, Lampertico P, Montagnino G, Passerini P, Villa M, Campise MR, et al. Natural history of hepatitis B and C in renal allograft recipients. Transplantation 2005;79(9):1132-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15880056" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 78 => array:3 [ "identificador" => "bib79" "etiqueta" => "79" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Morales JM, Marcén R, Andrés A, Domínguez-Gil B, Campistol JM, Gallego R, et al. Renal transplantation in patients with hepatitis C virus antibody. A long national experience. NDT Plus 2010;3(Suppl 2):ii41-ii46. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20508864" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 79 => array:3 [ "identificador" => "bib80" "etiqueta" => "80" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gheith OA, Saad MA, Hassan AA, A-Eldeeb S, Agroudy AE, Esaza H, et al. Hepatic dysfunction in kidney transplant recipients: prevalence and impact on graft and patient survival. Clin Exp Nephrol 2007;11(4):309-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18085393" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 80 => array:3 [ "identificador" => "bib81" "etiqueta" => "81" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hestin D, Guillermin F, Castin N, Le Faou A, Champigneulles J, Kessler M. Pretransplant hepatitis C virus infection: a predictor of proteinuria after renal transplantation. Transplantation 1998;65(5):741-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9521213" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 81 => array:3 [ "identificador" => "bib82" "etiqueta" => "82" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bloom RD, Rao V, Weng F, Grossman RA, Cohen D, Mange KC. Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus. J Am Soc Nephrol 2002;13(5):1374-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11961026" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 82 => array:3 [ "identificador" => "bib83" "etiqueta" => "83" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kamar N, Mariat C, Delahousse M, Dantal J, Al Najjar A, Cassuto E, et al. Diabetes mellitus after kidney transplantation: a French multicentre observational study. Nephrol Dial Transplant 2007;22(7):1986-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17400559" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 83 => array:3 [ "identificador" => "bib84" "etiqueta" => "84" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fabrizi F, Martin P, Dixit V, Bunnapradist S, Kanwal F, Dulai G. Post-transplant diabetes mellitus and HCV seropositive status after renal transplantation: meta-analysis of clinical studies. Am J Transplant 2005;5(10):2433-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16162192" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 84 => array:3 [ "identificador" => "bib85" "etiqueta" => "85" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Roth D, Cirocco R, Zucker K, Ruiz P, Viciana A, Burke G, et al. De novo membranoproliferative glomerulonephritis in hepatitis C virus-infected renal allograft recipients. Transplantation 1995;59(12):1676-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7541575" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 85 => array:3 [ "identificador" => "bib86" "etiqueta" => "86" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Floege J. Recurrent glomerulonephritis following renal transplantation: an update. Nephrol Dial Transplant 2003;18(7):1260-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12808159" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 86 => array:3 [ "identificador" => "bib87" "etiqueta" => "87" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Choy BY, Chan TM, Lai KN. Recurrent glomerulonephritis after kidney transplantation. Am J Transplant 2006;6(11):2535-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16939521" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 87 => array:3 [ "identificador" => "bib88" "etiqueta" => "88" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kamar N, Izopet J, Alric L, Guilbeaud-Frugier C, Rostaing L. Hepatitis C virus-related kidney disease: an overview. Clin Nephrol 2008;69(3):149-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18397713" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 88 => array:3 [ "identificador" => "bib89" "etiqueta" => "89" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Humar A, Crotteau S, Cruessner A, Kandaswamy R, Gruessner R, Payne W, et al. Steroid minimization in liver transplant recipients: impact on hepatitis C recurrente and post-transplant diabetes. Clin Transplant 2007;21(4):526-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17645714" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 89 => array:3 [ "identificador" => "bib90" "etiqueta" => "90" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Pascual J, Crespo M, Mateos ML, Marcén R, Orofino L, Burgos FJ, et al. Reduced severity of acute rejection in hepatitis C virus positive renal allograft recipients: are milder immunosuppressive regimens advisable? Transplant Proc 1998;30(4):1329-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9636540" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 90 => array:3 [ "identificador" => "bib91" "etiqueta" => "91" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kamar N, Ribes D, Izopet J, Rostaing L. Treatment of hepatitis C virus infection (HCV) after renal transplantation: implications for HCV-positive dialysis patients awaiting a kidney transplant. Transplantation 2006;82(7):853-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17038897" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 91 => array:3 [ "identificador" => "bib92" "etiqueta" => "92" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Toth CM, Pascual M, Chung RT, Graeme-Cook F, Dienstag JL, Bhan AK, et al. Hepatitis C virus-associated fibrosing cholestatic hepatitis after renal transplantation: response to interferon-alpha therapy. Transplantation 1998;66(9):1254-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9825826" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 92 => array:3 [ "identificador" => "bib93" "etiqueta" => "93" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Covic A, Maftei I-D, Mardare NGI, Ionita-Radu F, Totolici C, Tuta L, et al. Analysis of safety and efficacy of pegylated-interferon alpha-2a in hepatitis C virus positive hemodialysis patients: results from a large, multicenter audit. J Nephrol 2006;19(6):794-801. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17173254" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 93 => array:3 [ "identificador" => "bib94" "etiqueta" => "94" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tan SS, Abu Hassan MR, Abdullah A, Ooi BP, Korompis T, Merican MI. Safety and efficacy of an escalating dose regimen of pegylated interferon alpha-2b in the treatment of haemodialysis patients with chronic hepatitis C. J Viral Hepat 2010;17(6):410-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19758272" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 94 => array:3 [ "identificador" => "bib95" "etiqueta" => "95" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kokoglu OF, Ucmak H, Hosoglu S, Cetinkaya A, Kantarceken B, Buyukbese MA, et al. Efficacy and tolerability of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C. J Gastroenterol Hepatol 2006;21(3):575-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16638102" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 95 => array:3 [ "identificador" => "bib96" "etiqueta" => "96" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Russo MW, Ghalib R, Sigal J, Joshi V. Randomized trial of pegylated interferon ¿-2b monotherapy in haemodialysis patients with chronic hepatitis C. Nephrol Dial Transplant 2006;21(2):437-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16234288" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 96 => array:3 [ "identificador" => "bib97" "etiqueta" => "97" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Dienstag JL, McHutchinson JG. American Gastroenterological Association technical review on the management of hepatitis C. Gastroenterology 2006;130(1):231-64." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 97 => array:3 [ "identificador" => "bib98" "etiqueta" => "98" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bocci V, Pacini A, Muscettola M, Paulesu L, Pessina GP, Santiano M et al. Renal filtration, absorption and catabolism of human alpha interferon. J Interferon Res 1981;1(3):347-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6180066" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 98 => array:3 [ "identificador" => "bib99" "etiqueta" => "99" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bino T, Madar Z, Gertler A, Rosenberg H. The kidney is the main site of interferon degradation. J Interferon Res 1982;2(2):301-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7119510" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 99 => array:3 [ "identificador" => "bib100" "etiqueta" => "100" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kramer TH, Gaar GG, Ray CG, Minnich L, Copeland JG, Connor JD. Hemodialysis clearance of intravenously administered ribavirin. Antimicrob Agents Chemother 1990;34(3):489-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2334164" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109704007910" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 100 => array:3 [ "identificador" => "bib101" "etiqueta" => "101" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Glue P. The clinical pharmacology of ribavirin. Semin Liver Dis 1999;19(Suppl 1):17-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10349689" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 101 => array:3 [ "identificador" => "bib102" "etiqueta" => "102" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Uchihara M, Izumi N, Sakai Y, Yauchi T, Miyake S, Sakai T, et al. Interferon therapy for chronic hepatitis C in hemodialysis patients: increased serum levels of interferon. Nephron 1998;80(1):51-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9730703" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 102 => array:3 [ "identificador" => "bib103" "etiqueta" => "103" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Rostaing L, Chatelut E, Payen JL, Izopet J, Thalamas C, Ton-That H, et al. Pharmacokinetics of alpha IFN-2b in chronic hepatitis C virus patients undergoing chronic hemodialysis or with normal renal function: clinical implications. J Am Soc Nephrol 1998;9(12):2344-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9848789" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 103 => array:3 [ "identificador" => "bib104" "etiqueta" => "104" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Glue P, Fang JW, Rouzier-Panis R, Raffanel C, Sabo R, Gupta SK, et al. Pegylated interferon-alpha 2b: pharmacokinetics, pharmacodynamics, safety, and preliminary efficacy data. Hepatitis C Intervention Therapy Group. Clin Pharmacol Ther 2000;68(5):556-67." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 104 => array:3 [ "identificador" => "bib105" "etiqueta" => "105" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Gupta SK, Pittenger AL, Swan SK, Marbury TC, Tobillo E, Batra V, et al. Single-dose pharmacokinetics and safety of pegylated interferon alpha 2b in patients with chronic renal dysfunction. J Clin Pharmacol 2002;42(10):1109-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12362925" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 105 => array:3 [ "identificador" => "bib106" "etiqueta" => "106" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Luzon BA, Muir AJ, Heneghan MA. Safety and tolerability of pegylated interferon with or without low dose ribavirin for treatment of hepatitis C in hemodialysis. Hepatology 2005;42(Suppl):703A-704A." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 106 => array:3 [ "identificador" => "bib107" "etiqueta" => "107" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Hakim W, Sheik S, Inayat I, Bia M, Caldwell C, Jain D, et al. Inicial HCV response in patients with end stage renal disease treated with combination pegylated interferon alfa-2a and ribavirin. Presented at: Digestive Disease Week; May 20-25, 2006; Los Angeles, CA. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25644917" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 107 => array:3 [ "identificador" => "bib108" "etiqueta" => "108" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bruchfeld A, Lindahl K, Reichard O, Carlsson T, Schvarcz R. Pegylated interferon and ribavirin treatment for hepatitis C in haemodialysis patients. J Viral Herat 2006;13(5):316-21." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 108 => array:3 [ "identificador" => "bib109" "etiqueta" => "109" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mousa DH, Abadía AH, Al-Shoail G, Al-Sulaiman MH, Al-Hawas FA, Al-Khader AA. Alpha-interferon with ribavirin in haemodialyzed patients with chronic hepatitis C: a prospective study. Presented at: 57th Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, MA." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 109 => array:3 [ "identificador" => "bib110" "etiqueta" => "110" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Leusen R, Adang RP, De Vries RA, Cnossen TT, Konings CJ, Schalm SW, et al. Pegylated interferon alfa-2a (40 kD) and ribavirin in haemodialysis patients with chronic hepatitis C. Nephrol Dial Transplant 2008;23(2):721-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18042614" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 110 => array:3 [ "identificador" => "bib111" "etiqueta" => "111" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Carriero D, Fabrizi F, Uriel AJ, Park J, Martin P, Dieterich DT. Treatment of dialysis patients with chronic hepatitis C using pegylated interferon and low-dose ribavirin. Int J Artif Organs 2008;31(4):295-302. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18432584" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 111 => array:3 [ "identificador" => "bib112" "etiqueta" => "112" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fabrizi F, Dixit V, Martin P, Messa P. Combined antiviral therapy of hepatitis C virus in dialysis patients: meta-analysis of clinical trials. J Viral Hepat 2010. doi: 10.1111/j.1365-2893.2010.01405.x. [Epub ahead of print]" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 112 => array:3 [ "identificador" => "bib113" "etiqueta" => "113" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Tan AC, Brouwer JT, Glue P, Van Leusen R, Kauffmann RH, Schalm SW, et al. Safety of interferon and ribavirin therapy in haemodialysis patients with chronic hepatitis C: results of a pilot study. Nephrol Dial Transplant 2001;16(1):193-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11209032" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 113 => array:3 [ "identificador" => "bib114" "etiqueta" => "114" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139(2):137-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12859163" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 114 => array:3 [ "identificador" => "bib115" "etiqueta" => "115" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Barril G, González Parra E, Alcázar R, Arenas D, Campistol JM, Caramelo C, et al. Guía sobre enfermedades víricas en hemodiálisis. Nefrologia 2004;24(Suppl 2):43-66. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15085792" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 115 => array:3 [ "identificador" => "bib116" "etiqueta" => "116" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "García García M, Oppenheimer F, Valencia J. Valoración y seguimiento de inclusión en lista de espera para trasplante renal. Nefrologia 2006;26(Suppl 8):60-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17802669" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 116 => array:3 [ "identificador" => "bib117" "etiqueta" => "117" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Campistol JM, Darnell A. Protocolos del Servicio de Nefrología y Trasplante renal 2008. Hospital Clínic de Barcelona. Barcelona: Roche, 2008." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 117 => array:3 [ "identificador" => "bib118" "etiqueta" => "118" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Proceso asistencial integrado. Tratamiento sustitutivo de la IRC: diálisis y trasplante renal. Sevilla: Consejería de Salud. Junta de Andalucía, 2005." 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Manejo de la infección por el VHC en la enfermedad renal crónica

S.. Aoufi Rabiha, R.. García Agudob

a Servicio de Aparato Digestivo, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real,

b Servicio de Nefrología, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real,

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In Spain&#44; HCV is currently the main risk factor associated with hepatocellular carcinoma&#44;<span class="elsevierStyleSup">25</span> although the risk varies with the extent to which the liver is affected&#46; It is less than 1&#37; annually in patients with chronic hepatitis without significant fibrosis&#44; and reaches 3&#37;-7&#37; annually for cirrosis&#46;<span class="elsevierStyleSup">26</span> Once liver cirrhosis is found&#44; there is a risk of liver hepatocellular carcinoma continuing to develop&#44; despite having a sustained viral response to treatment&#46;<span class="elsevierStyleSup">27</span> Several factors for progression to cirrhosis have been identified&#58; advanced age&#44; obesity&#44; immunosuppression&#44; alcohol consumption greater than 50g&#47;day&#44;<span class="elsevierStyleSup">28-31</span> and a more rapid evolution to cirrhosis has been described in renal transplant patients&#46;<span class="elsevierStyleSup">32-34</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">LIVER HISTOLOGY&#58; ROLE OF BIOPSY</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A liver biopsy is of substantial value in assessing the severity of liver disease in chronic HCV infection&#44; in relation to the degree of fibrosis and necroinflammatory activity&#44; as well as for excluding other concomitant causes of liver dysfunction&#46; These include non-alcoholic fatty liver disease&#44; whose incidence is on the rise&#44; and haemosiderosis&#44; which may affect the progression of the disease and determine the response to treatment&#46;<span class="elsevierStyleSup">35-38</span> The KDIGO guides &#40;Kidney Disease Improving Global Outcomes&#41;<span class="elsevierStyleSup">39</span> recommend a liver biopsy in the liver disease study of patients eligible for renal transplantation&#46; The AASLD guide &#40;American Association for the Study of Liver Diseases&#41; limits it to HCV-positive patients with genotypes 1 and 4&#44; but considers it unnecessary in genotypes 2 and 3&#44;<span class="elsevierStyleSup">40</span> given that over 80&#37; 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Liver damage before renal transplantation is an independent predictor of poor long-term survival&#46;<span class="elsevierStyleSup">50</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Coagulopathy secondary to hepatocellular dysfunction and thrombocytopaenia due to portal hypertension and hypersplenism poses an increased risk of bleeding&#46;<span class="elsevierStyleSup">60</span> Due to the presence of ascites in CKD patients&#44; and because of the added risk of increased bleeding from platelet dysfunction associated with uraemia&#44; haemodialysis anticoagulation and antiplatelet therapy&#44; a liver biopsy via the transjugular or transfemoral route is often recommended&#46; This can provide additional diagnostic information&#44; such as the hepatic venous pressure gradient&#44; to confirm the existence of portal hypertension&#46;<span class="elsevierStyleSup">39&#44;40</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Desmopressin &#40;DDAVP&#44; 0&#46;3mg&#47;kg&#41; has been used more often immediately before liver biopsy in CKD patients&#46; However&#44; we were not able to find defined<span class="elsevierStyleBold"> </span><span class="elsevierStyleBold">serum creatinine level or glomerular filtration rates which should be used for desmopressin indication&#46;<span class="elsevierStyleSup">61</span></span><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The utility of non-invasive markers &#40;Index of Forns&#44; APRI or FIB-4&#41; in the study of liver damage in patients with CKD and HCV infection is not known at present&#46;<span class="elsevierStyleSup">62</span> There were hopes for transient elastography &#40;FibroScan&#41;&#44; which has failed to replace the biopsy&#58; it has not been approved by the FDA &#40;Food and Drug Administration&#41;&#44; the error rate is higher in obese patients and may be overestimated in acute hepatitis&#44; which is associated with high necroinflammatory activity and low or nil fibrosis&#46;<span class="elsevierStyleSup">63&#44;64</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">TREATMENT</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The treatment of choice for chronic HCV hepatitis is conventional or pegylated interferon&#44; alone or in combination with ribavirin&#46; The antiviral treatment should be individualised&#44; depending on the severity of the liver disease&#44; the possibility of serious adverse effects&#44; variability in the response to treatment&#44; the presence of comorbidity &#40;particularly renal failure&#41; and the patient&#39;s decision&#46;<span class="elsevierStyleSup">40</span> Individuals with CKD have lower to normal levels of transaminases<span class="elsevierStyleSup">45&#44;65-67</span> compared to those without CKD&#46; Traditionally&#44; it was considered that subjects with genotype 1 and persistently normal transaminases had minimal hepatic fibrosis and were thus not appropriate for treatment&#46; Today&#44; it has been shown that up to 25&#37; of these patients have significant fibrosis&#44; and that their response to treatment is similar to patients with elevated transaminases&#46;<span class="elsevierStyleSup">68-74</span> Patients with extrahepatic manifestations have to be treated&#44; 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and worsens liver disease and causes more infections&#46;<span class="elsevierStyleSup">39</span> In addition&#44; immunosuppression in renal transplantation enhances HCV reactivation&#46; In particular&#44; steroids have been associated with a 10 to 100 fold increase in the viral load&#46;<span class="elsevierStyleSup">88</span> They should therefore be avoided or minimised in HCV-positive patients&#46;<span class="elsevierStyleSup">89</span> In addition&#44; an increased frequency of fibrosing cholestatic hepatitis has been described which&#44; together with the rapid evolution to cirrhosis&#44; may significantly increase morbidity and mortality&#44; leading to the need for a liver transplant&#46;<span class="elsevierStyleSup">90&#44;91</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">However&#44; antiviral therapy in CKD remains controversial&#46; There are no comparative studies to support the decision of an appropriate antiviral treatment&#46; Most haemodialysis studies have investigated the use of conventional alpha interferon &#40;3MIU 3 times a week&#41; 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although some researchers have used it based on serum drug levels&#44; obtaining uneven results&#46;<span class="elsevierStyleSup">106-110&#44;112</span> Available data&#44; however&#44; are encouraging and its use may be indicated in centres where patient are treated by hepatologists and nephrologists&#46; Antiviral treatment in renal transplant recipients is rare except in cases with limited therapeutic alternatives or severe cholestatic hepatitis&#46;<span class="elsevierStyleSup">90&#44;91</span> The main drawback of antiviral treatment before transplantation is the delayed inclusion of the patient on the waiting list&#44; without being able to ensure HCV eradication due to the low response figures&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Therefore&#44; all haemodialysis patients with detectable HCV RNA and an F0-F2 METAVIR score should be considered as candidates for treatment with alpha interferon&#46; The bridging fibrosis patients with compensated cirrhosis should also receive antiviral therapy&#44; and be eventual candidates for renal transplantation if they achieve a sustained viral response&#46; Patients with decompensated cirrhosis should be evaluated for a combined kidney and liver transplant&#46;<span class="elsevierStyleSup">40</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In light of the impact of chronic HCV infection in renal transplantation&#44; it is recommended that patients with CKD are treated prior to undergoing the transplant&#46;<span class="elsevierStyleSup">113&#44;114</span> However&#44; despite the evidence on the benefits of antiviral treatment in patients with chronic HCV infection and CKD prior to renal transplantation&#44; only a few kidney transplant protocols recommend treatment against HCV&#44; and it is not usually listed as a pre-transplant criterion&#46;<span class="elsevierStyleSup">115-117</span> In fact&#44; the evaluation before a kidney transplant for HCV-positive patients on renal replacement therapy shows that&#44; as well as not considering treatment for HCV before transplantation&#44; hepatology monitoring of these patients on dialysis is virtually nonexistent in many cases&#46; This may be due to the inherent complexity of CKD treatment&#44; leading the nephrologist to assume all the patient pathology in haemodialysis&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Further studies are needed to assess the clinical situation and monitoring of HCV hepatitis in patients on haemodialysis&#44; to identify improvements and involve both nephrologists and hepatologists in its management&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10768&#95;16025&#95;14629&#95;en&#95;t1&#95;&#95;10768&#46;jpg" class="elsevierStyleCrossRefs"><img src="10768_16025_14629_en_t1__10768.jpg" alt="Prevalence of HCV infection in haemodialysis"></img></a></p><p class="elsevierStylePara">Table 1&#46; Prevalence of HCV infection in haemodialysis</p>"
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        "resumen" => "<p class="elsevierStylePara">The prevalence of chronic infection with the hepatitis C virus &#40;HCV&#41; in patients with chronic kidney disease is higher than in the general population&#46; The estimated prevalence is 13&#37; in haemodialysis&#44; with wide variations geographically and between units in the same country&#46;</p> <p class="elsevierStylePara">A liver biopsy is a useful tool for deciding whether to start antiviral therapy and to exclude concomitant causes of liver dysfunction&#46; Examples of this include non-alcoholic fatty liver disease&#44; whose incidence is on the rise&#44; and haemosiderosis&#44; which may affect the progression of the disease and determine the response to antiviral therapy&#46; In addition&#44; the transjugular approach can be used to measure the hepatic venous pressure gradient and confirm the existence of portal hypertension&#46;</p> <p class="elsevierStylePara">Chronic hepatitis due to HCV has been shown to reduce survival in haemodialysis&#44; renal transplantation and graft survival&#46; It is the fourth leading cause of death and the leading cause of post-renal transplantation liver dysfunction&#46; HCV behaves as an independent risk factor for the occurrence of proteinuria&#59; it increases the risk of developing diabetes mellitus&#44; de novo glomerulonephritis and chronic allograft nephropathy&#59; it leads to a deterioration in liver disease and causes a greater number of infections&#46; An increased frequency of fibrosing cholestatic hepatitis has also been described which&#44; together with the rapid evolution to cirrhosis&#44; can significantly increase morbidity and mortality and lead to the need for liver transplantation&#46; In addition&#44; immunosuppression in renal transplantation predisposes a reactivation of HCV&#46; However&#44; as the pharmacokinetics of interferon and ribavirin is impaired in kidney failure and their use has adverse effects on function and graft survival&#44; a combination therapy must be limited to non-transplanted individuals with an estimated glomerular filtration rate greater than 50ml&#47;min&#44; and with the interferon being used as monotherapy in dialysis&#46; The fact that a quarter of HCV-positive patients evaluated for a renal transplant have bridging fibrosis or cirrhosis in the liver biopsy may renew renal pre-transplant treatment planning&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara">La prevalencia de la infecci&#243;n cr&#243;nica por el virus de la hepatitis C &#40;VHC&#41; en pacientes con enfermedad renal cr&#243;nica es mayor que en la poblaci&#243;n general&#46; En hemodi&#225;lisis&#44; se estima una prevalencia del 13&#37;&#44; con una amplia variabilidad geogr&#225;fica y entre las unidades de un mismo pa&#237;s&#46; La biopsia hep&#225;tica es una herramienta &#250;til para decidir el inicio de la terapia antiviral y excluir causas concomitantes de disfunci&#243;n hep&#225;tica&#44; como la hepatopat&#237;a grasa no alcoh&#243;lica&#44; cuya incidencia est&#225; en auge&#44; y la hemosiderosis&#44; que pueden afectar a la progresi&#243;n de la enfermedad y condicionar la respuesta al tratamiento antiviral&#59; adem&#225;s&#44; la v&#237;a transyugular se puede utilizar para medir el gradiente de presi&#243;n venoso hep&#225;tico y confirmar la existencia de hipertensi&#243;n portal&#46; La hepatitis cr&#243;nica por el VHC ha demostrado reducir la supervivencia en hemodi&#225;lisis y en el trasplante renal&#44; as&#237; como la supervivencia del injerto&#46; Constituye la cuarta causa de mortalidad y la principal causa de disfunci&#243;n hep&#225;tica postrasplante renal&#46; El VHC se comporta como un factor de riesgo independiente para la aparici&#243;n de proteinuria&#44; aumenta el riesgo de desarrollar diabetes&#44; una glomerulonefritis de novo o una nefropat&#237;a cr&#243;nica del injerto&#44; de empeorar la enfermedad hep&#225;tica y de provocar un mayor n&#250;mero de infecciones&#46; Tambi&#233;n se ha descrito un incremento de la frecuencia de hepatitis colest&#225;sica fibrosante que&#44; junto a la evoluci&#243;n acelerada a cirrosis&#44; puede elevar significativamente la morbimortalidad y conllevar la necesidad de un trasplante hep&#225;tico&#46; Adem&#225;s&#44; la inmunosupresi&#243;n en el trasplante renal predispone a la reactivaci&#243;n del VHC&#46; Sin embargo&#44; como la farmacocin&#233;tica del interfer&#243;n y la ribavirina est&#225; alterada en la insuficiencia renal y su uso tiene efectos adversos sobre la funci&#243;n y la supervivencia del injerto&#44; la terapia combinada se limita a los individuos no trasplantados con un filtrado glomerular estimado mayor de 50 ml&#47;min y en di&#225;lisis suele emplearse el interfer&#243;n en monoterapia&#46; El hecho de que una cuarta parte de los pacientes VHC-positivos evaluados para trasplante renal tenga fibrosis en puente o cirrosis en la biopsia hep&#225;tica puede renovar el planteamiento del tratamiento pretrasplante renal&#46;</p>"
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                  "referenciaCompleta" => "Finelli L, Miller JT, Tokars JI, Alter MJ, Arduino MJ. National surveillance of dialysisassociated diseases in the United States, 2002. Semin Dial 2005;18(1):52-61.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15663766" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Espinosa M, Martín-Malo A, Ojeda R, Santamara R, Soriano S, Aguera M, et al. Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J Kidney Dis 2004;43(4):685-9.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/15042545" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
                    0 => null
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              ]
            ]
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              "identificador" => "bib4"
              "etiqueta" => "4"
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                0 => array:3 [
                  "referenciaCompleta" => "Jadoul M, Poignet JL, Geddes C, Locatelli F, Medin C, Krajewska M, et al. The changing epidemiology of hepatitis C virus (HCV) infection in haemodialysis: European multicentre study. Nephrol Dial Transplant 2004;19(4):904-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15031348" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
                    0 => null
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              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
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                0 => array:3 [
                  "referenciaCompleta" => "Fissell RB, Bragg-Gresaham JL, Woods JD, Jadoul M, Gillespie B, Hedderwick SA, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004;65(6):2335-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15149347" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sivapalasingam S, Malak SF, Sullivan JF, Lorch J, Sepkowitz KA. High prevalence of hepatitis C infection among patients receiving hemodialysis at an urban dialysis center. Infect Control Hosp Epidemiol 2002;23(6):319-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12083235" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hinrichsen H, Leimenstoll G, Stegen G, Schrader H, Fölsch UR, Schmidt WE; PHV Study Group. Prevalence and risk factors of hepatitis C virus infection in haemodialysis patients: a multicentre study in 2796 patients. Gut 2002;51(3):429-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12171969" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Huraib S, Al-Rashed R, Aldrees A, Aljefry M, Arif M, Al-Faleh FA. High prevalence of and risk factors for hepatitis C in haemodialysis patients in Saudi Arabia: a need for new dialysis strategies. Nephrol Dial Transplant 1995;10(4):470-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7623989" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Santos MA, Souto FJ. Infection by the hepatitis C virus in chronic renal failure patients undergoing hemodialysis in Mato Grosso state, central Brazil: a cohort study. BMC Public Health 2007;7:32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17352803" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Saha D, Agarwal SK. Hepatitis and HIV infection during haemodialysis. J Indian Med Assoc 2001;99(4):194-9."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "10.\u{A0} Shamshirsaz AA, Kamgar M, Bekheirnia MR, Ayazi F, Hashemi SR, Bouzari N, et al. The role of hemodialysis machines dedication in reducing Hepatitis C transmission in the dialysis setting in Iran: a multicenter prospective interventional study. BMC Nephrol 2004;5(1):13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15469615" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Blackmore TK, Stace NH, Maddocks P, Hatfield P. Prevalence of antibodies to hepatitis C virus in patients receiving renal replacement therapy, and in the staff caring for them. Aust N Z J Med 1992;22(4):353-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/1280095" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Schneeberger PM, Keur I, Van Loon AM, Mortier D, De Coul KO, Van Haperen AV, et al. The prevalence and incidence of hepatitis C virus infections among dialysis patients in the Netherlands: a nationwide prospective study. J Infect Dis 2000;182(5):1291-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11023452" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hruby Z, Sliwinski J, Molin I, Zalewska M, Knysz B, Czyz W, et al. High prevalence of antibodies to hepatitis C virus in three haemodialysis centres in south-western Poland. Nephrol Dial Transplant 1993;8(8):740-3. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7692355" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cassidy MJ, Jankelson D, Becker M, Dunne T, Walzl G, Moosa MR. The prevalence of antibodies to hepatitis C virus at two haemodialysis units in South Africa. S Afr Med J 1995;85(10):996-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8596992" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Luengrojanakul P, Vareesangthip K, Chainuvati T, Murata K, Tsuda F, Tokita H, et al. Hepatitis C virus infection in patients with chronic liver disease or chronic renal failure and blood donors in Thailand. J Med Virol 1994;44(3):287-92. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7531758" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "identificador" => "bib17"
              "etiqueta" => "17"
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                0 => array:3 [
                  "referenciaCompleta" => "Hmaied F, Ben Mamou M, Saune-Sandres K, Rostaing L, Slim A, Arrouji Z, et al. Hepatitis C virus infection among dialysis patients in Tunisia: incidence and molecular evidence for nosocomial transmission. J Med Virol 2006;78(2):185-91. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16372289" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
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              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pereira BJ, Natov SN, Bouthot BA, Murthy BV, Ruthazer R, Schmid CH, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1998;53(5):1374-81. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9573555" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hanafusa T, Ichikawa Y, Kishikawa H, Kyo M, Fukunishi T, Kokado Y, et al. Retrospective study on the impact of hepatitis C virus infection on kidney transplant patients over 20 years. Transplantation 1998;66(4):471-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9734490" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Vosnides GG. Hepatitis C in renal transplantation. Kidney Int 1997;52(3):843-61. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9291208" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment and prevention of hepatitis C. Ann Intern Med 2000;132(4):296-305."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "21.\u{A0}Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis 2005;9(3):383-98."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Strader DB, Seeff LB. The natural history of chronic hepatitis C infection. Eur J Gastroenterol Hepatol 1996;8(4):324-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8781898" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Seeff LB, Hoofnagle JH. National Institutes of Health Consensus Development Conference: management of hepatitis C: 2002. Hepatology 2002;36(5 Suppl 1):S1-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12407571" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Seeff LB. Natural history of chronic hepatitis C. Hepatology 2002;36(5 Suppl 1):S35-S46."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Forner A, Ayuso C, Real MI, Sastre J, Robles R, Sangro B, et al. Diagnóstico y tratamiento del carcinoma hepatocelular. Med Clin (Barc) 2009;132(7):272-87."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: Incidente and risk factors. Gastroenterology 2004;127(5 Suppl 1):S35-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15508101" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bruno S, Stroffolini T, Colombo M, Bollani S, Benvegnu L, Mazzella G, et al. Sustained virological response to interferon-alpha is associated with improved outcome in HCV-related cirrhosis: A retrospective study. Hepatology 2007;45(3):579-87. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17326216" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Benhamou Y, Bochet M, Di Martino V, Charlotte F, Azria F, Coutellier A, et al. Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group. Hepatology 1999;30(4):1054-8."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. The OBSVIRC, METAVIR, CLINIVIR, and DOSVIRC groups. Lancet 1997;349(9055):825-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9121257" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Harris DR, Gonin R, Alter HJ, Wright EC, Buskell ZJ, Hollinger FB, et al. The relationship of acute transfusion-associated hepatitis to the development of cirrhosis in the presence of alcohol abuse. Ann Intern Med 2001;134(2):120-4.  <a href="http://www.ncbi.nlm.nih.gov/pubmed/11177315" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Powell EE, Jonsson JR, Clouston AD. Steatosis: co-factor in other liver diseases. Hepatology 2005;42(1):5-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15962320" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Marcelli D, Stannard D, Conte F, Held PJ, Locatelli F, Port FK. ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. Kidney Int 1996;50(3):1013-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8872978" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 1999;354(9173):93-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10408483" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib35"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Nakayama E, Akiba T, Marumo F, Sato C. Prognosis of anti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy. J Am Soc Nephrol 2000;11(10):1896-902. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11004221" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib36"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kleiner DE. The liver biopsy in chronic hepatitis C: a view from the other side of the microscope. Semin Liver Dis 2005;25(1):52-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15731997" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib37"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Rubbia-Brandt L, Fabris P, Paganin S, Leandro G, Male PJ, Giostra E, et al. Steatosis affects chronic hepatitis C progression in a genotype specific way. Gut 2004;53(3):406-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14960525" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib38"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Poynard T, Ratziu V, McHutchison J, Manns M, Goodman Z, Zeuzem S, et al. Effect of treatment with peginterferon or interferon alfa-2b and ribavirin on steatosis in patients infected with hepatitis C. Hepatology 2003;38(1):75-85. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12829989" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            38 => array:3 [
              "identificador" => "bib39"
              "etiqueta" => "39"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Olynyk JK, Reddy KR, Di Bisceglie AM, Jeffers LJ, Parker TI, Radick JL, et al. Hepatic iron concentration as a predictor of response to interferon alfa therapy in chronic hepatitis C. Gastroenterology 1995;108(4):1104-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7698578" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109706026581"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            39 => array:3 [
              "identificador" => "bib40"
              "etiqueta" => "40"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kidney Disease Improving Global Outcomes. Clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int 2008;73(Suppl 109):S53-S68."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            40 => array:3 [
              "identificador" => "bib41"
              "etiqueta" => "41"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Ghany MG, Strader DB, Thomas DL, Seeff LB; American Association for the Study of Liver Diseases. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology 2009;49(4):1335-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19330875" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            41 => array:3 [
              "identificador" => "bib42"
              "etiqueta" => "42"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Knodell RG, Ishak KG, Black WC, et al. Formulation and application of a numeral scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1981;1(5):431-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7308988" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            42 => array:3 [
              "identificador" => "bib43"
              "etiqueta" => "43"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med 2001;344(7):495-500. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11172192" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            43 => array:3 [
              "identificador" => "bib44"
              "etiqueta" => "44"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002;97(10):2614-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12385448" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            44 => array:3 [
              "identificador" => "bib45"
              "etiqueta" => "45"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martin P, Carter D, Fabrizi F, Dixit V, Conrad AJ, Artinian L, et al. Histopathological features of hepatitis C in renal transplant candidates. Transplantation 2000;69(7):1479-84. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10798774" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:1 [
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109710037186"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            45 => array:3 [
              "identificador" => "bib46"
              "etiqueta" => "46"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Caramelo C, Ortiz A, Aguilera B, Porres JC, Navas S, Marriott E, et al. Liver disease patterns in hemodialysis patients with antibodies to hepatitis C virus. Am J Kidney Dis 1993;22(6):822-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7504404" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            46 => array:3 [
              "identificador" => "bib47"
              "etiqueta" => "47"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Cotler SJ, Diaz G, Gundlapalli S, Jakate S, Chawla A, Mital D, et al. Characteristics of hepatitis C in renal transplant candidates. J Clin Gastroenterol 2002;35(2):191-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12172367" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            47 => array:3 [
              "identificador" => "bib48"
              "etiqueta" => "48"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Glicklich D, Thung SN, Kapoian T, Tellis V, Reinus JF. Comparison of clinical features and liver histology in hepatitis C-positive dialysis patients and renal transplant recipients. Am J Gastroenterol 1999;94(1):159-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9934748" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            48 => array:3 [
              "identificador" => "bib49"
              "etiqueta" => "49"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pol S, Romeo R, Zins B, Driss F, Lebkiri B, Carnot F, et al. Hepatitis C virus RNA in anti-HCV positive hemodialyzed patients: significance and therapeutic implications. Kidney Int 1993;44(5):1097-100. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8264141" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            49 => array:3 [
              "identificador" => "bib50"
              "etiqueta" => "50"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sterling RK, Sanyal AJ, Luketic VA, Stravitz RT, King AL, Post AB, et al. Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation. Am J Gastroenterol 1999;94(12):3576-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10606322" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            50 => array:3 [
              "identificador" => "bib51"
              "etiqueta" => "51"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Mathurin P, Mouquet C, Poynard T, Sylla C, Benalia H, Fretz C, et al. Impact of hepatitis B and C virus on kidney transplantation outcome. Hepatology 1999;29(1):257-63."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            51 => array:3 [
              "identificador" => "bib52"
              "etiqueta" => "52"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Breitenfeldt MK, Rasenack J, Berthold H, Olschewski M, Schroff J, Strey C, et al. Impact of hepatitis B and C on graft loss and mortality of patients after kidney transplantation. Clin Transplant 2002;16(2):130-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11966783" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            52 => array:3 [
              "identificador" => "bib53"
              "etiqueta" => "53"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bruchfeld A, Wilczek H, Elinder CG. Hepatitis C infection, time in renal replacement therapy, and outcome after kidney transplantation. Transplantation 2004;78(5):745-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15371680" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            53 => array:3 [
              "identificador" => "bib54"
              "etiqueta" => "54"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Morales JM, Domínguez-Gil B, Sanz-Guajardo D, Fernández J, Escuin F. The influence of hepatitis B and hepatitis C virus infection in the recipient on late renal allograft failure. Nephrol Dial Transplant 2004;19(Suppl 3):iii72-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15192141" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            54 => array:3 [
              "identificador" => "bib55"
              "etiqueta" => "55"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gentil MA, Rocha JL, Rodríguez-Algarra G, Pereira P, López R, Bernal G, et al. Impaired kidney transplant survival in patients with antibodies to hepatitis C virus. Nephrol Dial Transplant 1999;14(10):2455-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10528672" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            55 => array:3 [
              "identificador" => "bib56"
              "etiqueta" => "56"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Legendre C, Garrigue V, Le Bihan C, Mamzer-Bruneel MF, Chaix ML, Landais P, et al. Harmful long-term impact of hepatitis C virus infection in kidney transplant recipients. Transplantation 1998;65(5):667-70. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9521201" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            56 => array:3 [
              "identificador" => "bib57"
              "etiqueta" => "57"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Murthy BV, Muerhoff AS, Desai SM, Yamaguchi J, Mushahwar IK, Schmid CH, et al. Impact of pretransplantation GB virus C infection on the outcome of renal transplantation. J Am Soc Nephrol 1997;8(7):1164-73. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9219167" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            57 => array:3 [
              "identificador" => "bib58"
              "etiqueta" => "58"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kamar N, Rostaing L, Selves J, Sandres-Saune K, Alric L, Durand D. Natural history of hepatitis C virus-related liver fibrosis after renal transplantation. Am J Transplant 2005;5(7):1704-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15943629" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            58 => array:3 [
              "identificador" => "bib59"
              "etiqueta" => "59"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Zylberberg H, Nalpas B, Carnot F, Skhiri H, Fontaine H, Legendre C, et al. Severe evolution of chronic hepatitis C in renal transplantation: a case control study. Nephrol Dial Transplant 2002;17(1):129-33. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11773476" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            59 => array:3 [
              "identificador" => "bib60"
              "etiqueta" => "60"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "U.S. Renal Data System, USRDS 2002 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, in, Bethesda, MD, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2002."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            60 => array:3 [
              "identificador" => "bib61"
              "etiqueta" => "61"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Caldwell SH, Hoffman M, Lisman T, Macik BG, Northup PG, Reddy KR, et al. Coagulation disorders and hemostasis in liver disease: pathophysiology and critical assesment of current management. Hepatology 2006;44(4):1039-46. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17006940" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            61 => array:3 [
              "identificador" => "bib62"
              "etiqueta" => "62"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "DiMichele DM, Hathaway WE. Use of DDAVP in inherited and acquired platelet dysfunction. Am J Hematol 1990;33(1):39-45. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2293761" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            62 => array:3 [
              "identificador" => "bib63"
              "etiqueta" => "63"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Campbell MS, Reddy KR. Review article: the evolving role of liver biopsy. Aliment Pharmacol Ther 2004;20(3):249-59. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15274661" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            63 => array:3 [
              "identificador" => "bib64"
              "etiqueta" => "64"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Arena U, Vizzutti F, Corti G, Ambu S, Stasi C, Bresci S, et al. Acute viral hepatitis increases liver stiffness values measured by transient elastography. Hepatology 2008;47(2):380-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18095306" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            64 => array:3 [
              "identificador" => "bib65"
              "etiqueta" => "65"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Sagir A, Erhardt A, Schmitt M, Häussinger D. Transient elastography is unreliable for detection of cirrhosis in patients with acute liver damage. Hepatology 2008;47(2):592-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18098325" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            65 => array:3 [
              "identificador" => "bib66"
              "etiqueta" => "66"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Espinosa M, Martín-Malo A, Álvarez de Lara MA, Soriano S, Aljama P. High ALT levels predict viremia in anti-HCV-positive HD patients if a modified normal range of ALT is applied. Clin Nephrol 2000;54(2):151-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10968693" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            66 => array:3 [
              "identificador" => "bib67"
              "etiqueta" => "67"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Guh JY, Lai YH, Yang CY, Chen SC, Chuang WL, Hsu TC, et al. Impact of decreased serum transaminase levels on the evaluation of viral hepatitis in hemodialysis patients. Nephron 1995;69(4):459-65. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7777113" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            67 => array:3 [
              "identificador" => "bib68"
              "etiqueta" => "68"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fabrizi F, Lunghi G, Finazzi S, Colucci P, Pagano A, Ponticelli C, et al. Decreased serum aminotransferase activity in patients with chronic renal failure: impact on the detection of viral hepatitis. Am J Kidney Dis 2001;38(5):1009-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11684554" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            68 => array:3 [
              "identificador" => "bib69"
              "etiqueta" => "69"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Martinot-Peignoux M, Boyer N, Cazals-Hatem D, Pham BN, Gervais A, Le Breton V, et al. Prospective study on anti-hepatitis C virus-positive patients with persistently normal serum alanine transaminase with or without detectable serum hepatitis C virus RNA. Hepatology 2001;34(5):1000-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11679971" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            69 => array:3 [
              "identificador" => "bib70"
              "etiqueta" => "70"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Shiffman ML, Diago M, Tran A, Pockros P, Reindollar R, Prati D, et al. Chronic hepatitis C in patients with persistently normal alanine transaminase levels. Clin Gastroenterol Hepatol 2006;4(5):645-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16630770" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            70 => array:3 [
              "identificador" => "bib71"
              "etiqueta" => "71"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Boccato S, Pistis R, Noventa F, Guido M, Benvegnù L, Alberti A. Fibrosis progression in initially mild chronic hepatitis C. J Viral Hepat 2006;13(5):297-302. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16637859" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            71 => array:3 [
              "identificador" => "bib72"
              "etiqueta" => "72"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Persico M, Persico E, Suozzo R, Conte S, De Seta M, Coppola L, et al. Natural history of hepatitis C virus carriers with persistently normal aminotransferase levels. Gastroenterology 2000;118(4):760-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10734027" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            72 => array:3 [
              "identificador" => "bib73"
              "etiqueta" => "73"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yu ML, Dai CY, Lee LP, Hou NJ, Hsieh MY, Huang JF, et al. A 24-week course of high-dose interferon-alpha plus ribavirin for Taiwanese chronic hepatitis C patients with persistently normal or near-normal alanine aminotransferase levels. Liver Int 2006;26(10):1187-95. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17105583" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            73 => array:3 [
              "identificador" => "bib74"
              "etiqueta" => "74"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Jacobson IM, Ahmed F, Russo MW, Lebovics E, Dieterich DT, Esposito SP, et al. Interferon alfa-2b [correction of alpha-2b] and ribavirin for patients with chronic hepatitis C and normal ALT. Am J Gastroenterol 2004;99(9):1700-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15330905" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            74 => array:3 [
              "identificador" => "bib75"
              "etiqueta" => "75"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Zeuzem S, Diago M, Gane E, Reddy KR, Pockros P, Prati D, et al. Peginterferon alfa-2a (40 kilodaltons) and ribavirin in patients with chronic hepatitis C and normal aminotransferase levels. Gastroenterology 2004;127(6):1724-32. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15578510" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            75 => array:3 [
              "identificador" => "bib76"
              "etiqueta" => "76"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Yee HS, Curie SL, Darling JM, Wright TL. Management and treatment of hepatitis C viral infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office. Am J Gastroenterol 2006;101(10):2360-78. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17032203" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            76 => array:3 [
              "identificador" => "bib77"
              "etiqueta" => "77"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Lee WC, Shu KH, Cheng CH, Wu MJ, Chen CH, Lian JC. Long-term impact of hepatitis B, C virus infection on renal transplantation. Am J Nephrol 2001;21 (4):300-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11509802" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            77 => array:3 [
              "identificador" => "bib78"
              "etiqueta" => "78"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Aroldi A, Lampertico P, Montagnino G, Passerini P, Villa M, Campise MR, et al. Natural history of hepatitis B and C in renal allograft recipients. Transplantation 2005;79(9):1132-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15880056" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            78 => array:3 [
              "identificador" => "bib79"
              "etiqueta" => "79"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Morales JM, Marcén R, Andrés A, Domínguez-Gil B, Campistol JM, Gallego R, et al. Renal transplantation in patients with hepatitis C virus antibody. A long national experience. NDT Plus 2010;3(Suppl 2):ii41-ii46. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20508864" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            79 => array:3 [
              "identificador" => "bib80"
              "etiqueta" => "80"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Gheith OA, Saad MA, Hassan AA, A-Eldeeb S, Agroudy AE, Esaza H, et al. Hepatic dysfunction in kidney transplant recipients: prevalence and impact on graft and patient survival. Clin Exp Nephrol 2007;11(4):309-15. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18085393" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            80 => array:3 [
              "identificador" => "bib81"
              "etiqueta" => "81"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Hestin D, Guillermin F, Castin N, Le Faou A, Champigneulles J, Kessler M. Pretransplant hepatitis C virus infection: a predictor of proteinuria after renal transplantation. Transplantation 1998;65(5):741-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9521213" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            81 => array:3 [
              "identificador" => "bib82"
              "etiqueta" => "82"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bloom RD, Rao V, Weng F, Grossman RA, Cohen D, Mange KC. Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus. J Am Soc Nephrol 2002;13(5):1374-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11961026" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            82 => array:3 [
              "identificador" => "bib83"
              "etiqueta" => "83"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kamar N, Mariat C, Delahousse M, Dantal J, Al Najjar A, Cassuto E, et al. Diabetes mellitus after kidney transplantation: a French multicentre observational study. Nephrol Dial Transplant 2007;22(7):1986-93. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17400559" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            83 => array:3 [
              "identificador" => "bib84"
              "etiqueta" => "84"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Fabrizi F, Martin P, Dixit V, Bunnapradist S, Kanwal F, Dulai G. Post-transplant diabetes mellitus and HCV seropositive status after renal transplantation: meta-analysis of clinical studies. Am J Transplant 2005;5(10):2433-40. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16162192" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            84 => array:3 [
              "identificador" => "bib85"
              "etiqueta" => "85"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Roth D, Cirocco R, Zucker K, Ruiz P, Viciana A, Burke G, et al. De novo membranoproliferative glomerulonephritis in hepatitis C virus-infected renal allograft recipients. Transplantation 1995;59(12):1676-82. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7541575" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            85 => array:3 [
              "identificador" => "bib86"
              "etiqueta" => "86"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Floege J. Recurrent glomerulonephritis following renal transplantation: an update. Nephrol Dial Transplant 2003;18(7):1260-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12808159" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            86 => array:3 [
              "identificador" => "bib87"
              "etiqueta" => "87"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Choy BY, Chan TM, Lai KN. Recurrent glomerulonephritis after kidney transplantation. Am J Transplant 2006;6(11):2535-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16939521" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            87 => array:3 [
              "identificador" => "bib88"
              "etiqueta" => "88"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kamar N, Izopet J, Alric L, Guilbeaud-Frugier C, Rostaing L. Hepatitis C virus-related kidney disease: an overview. Clin Nephrol 2008;69(3):149-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18397713" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            88 => array:3 [
              "identificador" => "bib89"
              "etiqueta" => "89"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Humar A, Crotteau S, Cruessner A, Kandaswamy R, Gruessner R, Payne W, et al. Steroid minimization in liver transplant recipients: impact on hepatitis C recurrente and post-transplant diabetes. Clin Transplant 2007;21(4):526-31. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17645714" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            89 => array:3 [
              "identificador" => "bib90"
              "etiqueta" => "90"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Pascual J, Crespo M, Mateos ML, Marcén R, Orofino L, Burgos FJ, et al. Reduced severity of acute rejection in hepatitis C virus positive renal allograft recipients: are milder immunosuppressive regimens advisable? Transplant Proc 1998;30(4):1329-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9636540" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            90 => array:3 [
              "identificador" => "bib91"
              "etiqueta" => "91"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Kamar N, Ribes D, Izopet J, Rostaing L. Treatment of hepatitis C virus infection (HCV) after renal transplantation: implications for HCV-positive dialysis patients awaiting a kidney transplant. Transplantation 2006;82(7):853-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17038897" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            91 => array:3 [
              "identificador" => "bib92"
              "etiqueta" => "92"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Toth CM, Pascual M, Chung RT, Graeme-Cook F, Dienstag JL, Bhan AK, et al. Hepatitis C virus-associated fibrosing cholestatic hepatitis after renal transplantation: response to interferon-alpha therapy. Transplantation 1998;66(9):1254-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9825826" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
                    0 => null
                  ]
                ]
              ]
            ]
            92 => array:3 [
              "identificador" => "bib93"
              "etiqueta" => "93"
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                0 => array:3 [
                  "referenciaCompleta" => "Kokoglu OF, Ucmak H, Hosoglu S, Cetinkaya A, Kantarceken B, Buyukbese MA, et al. Efficacy and tolerability of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C. J Gastroenterol Hepatol 2006;21(3):575-80. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16638102" target="_blank">[Pubmed]</a>"
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                0 => array:3 [
                  "referenciaCompleta" => "Russo MW, Ghalib R, Sigal J, Joshi V. Randomized trial of pegylated interferon ¿-2b monotherapy in haemodialysis patients with chronic hepatitis C. Nephrol Dial Transplant 2006;21(2):437-43. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16234288" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "etiqueta" => "97"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Dienstag JL, McHutchinson JG. American Gastroenterological Association technical review on the management of hepatitis C. Gastroenterology 2006;130(1):231-64."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Bocci V, Pacini A, Muscettola M, Paulesu L, Pessina GP, Santiano M et al. Renal filtration, absorption and catabolism of human alpha interferon. J Interferon Res 1981;1(3):347-52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/6180066" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Bino T, Madar Z, Gertler A, Rosenberg H. The kidney is the main site of interferon degradation. J Interferon Res 1982;2(2):301-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7119510" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Kramer TH, Gaar GG, Ray CG, Minnich L, Copeland JG, Connor JD. Hemodialysis clearance of intravenously administered ribavirin. Antimicrob Agents Chemother 1990;34(3):489-90. <a href="http://www.ncbi.nlm.nih.gov/pubmed/2334164" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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              "etiqueta" => "101"
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                0 => array:3 [
                  "referenciaCompleta" => "Glue P. The clinical pharmacology of ribavirin. Semin Liver Dis 1999;19(Suppl 1):17-24. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10349689" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Uchihara M, Izumi N, Sakai Y, Yauchi T, Miyake S, Sakai T, et al. Interferon therapy for chronic hepatitis C in hemodialysis patients: increased serum levels of interferon. Nephron 1998;80(1):51-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9730703" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Rostaing L, Chatelut E, Payen JL, Izopet J, Thalamas C, Ton-That H, et al. Pharmacokinetics of alpha IFN-2b in chronic hepatitis C virus patients undergoing chronic hemodialysis or with normal renal function: clinical implications. J Am Soc Nephrol 1998;9(12):2344-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9848789" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
                  "referenciaCompleta" => "Glue P, Fang JW, Rouzier-Panis R, Raffanel C, Sabo R, Gupta SK, et al. Pegylated interferon-alpha 2b: pharmacokinetics, pharmacodynamics, safety, and preliminary efficacy data. Hepatitis C Intervention Therapy Group. Clin Pharmacol Ther 2000;68(5):556-67."
                  "contribucion" => array:1 [
                    0 => null
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                0 => array:3 [
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                  "contribucion" => array:1 [
                    0 => null
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              "etiqueta" => "106"
              "referencia" => array:1 [
                0 => array:3 [
                  "referenciaCompleta" => "Luzon BA, Muir AJ, Heneghan MA. Safety and tolerability of pegylated interferon with or without low dose ribavirin for treatment of hepatitis C in hemodialysis. Hepatology 2005;42(Suppl):703A-704A."
                  "contribucion" => array:1 [
                    0 => null
                  ]
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                0 => array:3 [
                  "referenciaCompleta" => "Hakim W, Sheik S, Inayat I, Bia M, Caldwell C, Jain D, et al. Inicial HCV response in patients with end stage renal disease treated with combination pegylated interferon alfa-2a and ribavirin. Presented at: Digestive Disease Week; May 20-25, 2006; Los Angeles, CA. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25644917" target="_blank">[Pubmed]</a>"
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                0 => array:3 [
                  "referenciaCompleta" => "Bruchfeld A, Lindahl K, Reichard O, Carlsson T, Schvarcz R. Pegylated interferon and ribavirin treatment for hepatitis C in haemodialysis patients. J Viral Herat 2006;13(5):316-21."
                  "contribucion" => array:1 [
                    0 => null
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                  "host" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Mousa DH, Abadía AH, Al-Shoail G, Al-Sulaiman MH, Al-Hawas FA, Al-Khader AA. Alpha-interferon with ribavirin in haemodialyzed patients with chronic hepatitis C: a prospective study. Presented at: 57th Annual Meeting of the American Association for the Study of Liver Diseases; October 27-31, 2006; Boston, MA."
                  "contribucion" => array:1 [
                    0 => null
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                  "referenciaCompleta" => "Carriero D, Fabrizi F, Uriel AJ, Park J, Martin P, Dieterich DT. Treatment of dialysis patients with chronic hepatitis C using pegylated interferon and low-dose ribavirin. Int J Artif Organs 2008;31(4):295-302. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18432584" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Fabrizi F, Dixit V, Martin P, Messa P. Combined antiviral therapy of hepatitis C virus in dialysis patients: meta-analysis of clinical trials. J Viral Hepat 2010. doi: 10.1111/j.1365-2893.2010.01405.x. [Epub ahead of print]"
                  "contribucion" => array:1 [
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                  "referenciaCompleta" => "Tan AC, Brouwer JT, Glue P, Van Leusen R, Kauffmann RH, Schalm SW, et al. Safety of interferon and ribavirin therapy in haemodialysis patients with chronic hepatitis C: results of a pilot study. Nephrol Dial Transplant 2001;16(1):193-5. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11209032" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Levey AS, Coresh J, Balk E, Kausz AT, Levin A, Steffes MW, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003;139(2):137-47. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12859163" target="_blank">[Pubmed]</a>"
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                  "referenciaCompleta" => "Barril G, González Parra E, Alcázar R, Arenas D, Campistol JM, Caramelo C, et al. Guía sobre enfermedades víricas en hemodiálisis. Nefrologia 2004;24(Suppl 2):43-66. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15085792" target="_blank">[Pubmed]</a>"
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                0 => array:3 [
                  "referenciaCompleta" => "García García M, Oppenheimer F, Valencia J. Valoración y seguimiento de inclusión en lista de espera para trasplante renal. Nefrologia 2006;26(Suppl 8):60-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17802669" target="_blank">[Pubmed]</a>"
                  "contribucion" => array:1 [
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                0 => array:3 [
                  "referenciaCompleta" => "Campistol JM, Darnell A. Protocolos del Servicio de Nefrología y Trasplante renal 2008. Hospital Clínic de Barcelona. Barcelona: Roche, 2008."
                  "contribucion" => array:1 [
                    0 => null
                  ]
                  "host" => array:1 [
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Article information

ISSN: 20132514
Original language: English

DOI:10.3265/Nefrologia.pre2011.Jan.10768

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Year/Month	Html	Pdf	Total

2024 November	8	7	15
2024 October	72	47	119
2024 September	76	38	114
2024 August	70	81	151
2024 July	43	61	104
2024 June	51	36	87
2024 May	58	39	97
2024 April	56	38	94
2024 March	47	37	84
2024 February	34	39	73
2024 January	41	26	67
2023 December	28	32	60
2023 November	46	35	81
2023 October	33	26	59
2023 September	42	41	83
2023 August	45	33	78
2023 July	27	29	56
2023 June	26	27	53
2023 May	32	34	66
2023 April	19	16	35
2023 March	26	26	52
2023 February	15	16	31
2023 January	31	27	58
2022 December	36	36	72
2022 November	38	31	69
2022 October	37	51	88
2022 September	39	30	69
2022 August	33	46	79
2022 July	27	34	61
2022 June	35	45	80
2022 May	40	33	73
2022 April	49	61	110
2022 March	47	62	109
2022 February	35	48	83
2022 January	44	39	83
2021 December	27	46	73
2021 November	77	37	114
2021 October	141	46	187
2021 September	80	44	124
2021 August	53	56	109
2021 July	49	48	97
2021 June	34	22	56
2021 May	45	41	86
2021 April	95	77	172
2021 March	78	31	109
2021 February	43	30	73
2021 January	33	23	56
2020 December	38	13	51
2020 November	32	28	60
2020 October	21	20	41
2020 September	28	8	36
2020 August	33	18	51
2020 July	49	20	69
2020 June	24	12	36
2020 May	41	20	61
2020 April	30	19	49
2020 March	29	19	48
2020 February	46	18	64
2020 January	61	28	89
2019 December	63	28	91
2019 November	34	28	62
2019 October	35	12	47
2019 September	48	20	68
2019 August	45	24	69
2019 July	51	30	81
2019 June	35	13	48
2019 May	46	24	70
2019 April	50	55	105
2019 March	37	30	67
2019 February	18	12	30
2019 January	37	28	65
2018 December	93	45	138
2018 November	102	23	125
2018 October	103	27	130
2018 September	74	24	98
2018 August	58	18	76
2018 July	49	26	75
2018 June	33	11	44
2018 May	46	15	61
2018 April	33	7	40
2018 March	33	10	43
2018 February	47	5	52
2018 January	38	9	47
2017 December	57	9	66
2017 November	43	14	57
2017 October	52	7	59
2017 September	46	14	60
2017 August	35	15	50
2017 July	43	13	56
2017 June	49	8	57
2017 May	56	15	71
2017 April	59	10	69
2017 March	42	29	71
2017 February	41	13	54
2017 January	34	9	43
2016 December	83	5	88
2016 November	124	19	143
2016 October	129	15	144
2016 September	146	5	151
2016 August	267	11	278
2016 July	205	20	225
2016 June	158	0	158
2016 May	151	0	151
2016 April	140	0	140
2016 March	132	0	132
2016 February	134	0	134
2016 January	153	0	153
2015 December	151	0	151
2015 November	145	0	145
2015 October	105	0	105
2015 September	83	0	83
2015 August	101	0	101
2015 July	95	0	95
2015 June	34	0	34
2015 May	57	0	57
2015 April	5	0	5

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