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Vol. 31. Issue. 5.September 2011
Pages 0-626
Vol. 31. Issue. 5.September 2011
Pages 0-626
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Response to the comment made on Treatment of HCV infection in chronic kidney disease
Respuesta al comentario sobre el Manejo de la infección por el virus de la hepatitis C en la enfermedad renal crónica
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Rebeca García Agudoa, R.. García Agudob, Sami Aoufi Rabihc, S.. Aoufi Rabihd
a Servicio de Nefrología, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain,
b Servicio de Nefrología, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real,
c Servicio de Aparato Digestivo, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain,
d Servicio de Aparato Digestivo, Complejo Hospitalario La Mancha-Centro, Alcázar de San Juan, Ciudad Real,
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To the Editor,

Haemodialysis units’ health policies and protocols are disparate meaning that prevalence of chronic hepatitis C infection is extremely variable in the haemodialysis population.1-3 In some countries classic infection factors, such as material contaminated due to reuse or blood transfusions, have been replaced by parenteral drug addiction or sexual transmission.4,5 It is not surprising that prevention is the most adequate and cost-effective control measure for these patients.

Treating chronic HCV before kidney transplantation is currently not an essential criteria for including HCV-positive patients on the transplant waiting list. However, risk of post-transplant chronic hepatitis C and the difficulty to treat it at this stage of the chronic kidney disease have been reported.6-11

Pegylated interferon and interferon + ribavirin are better than conventional interferon, according to clinical trials. However, the differences are small. Combining ribavirin and pegylated interferon requires close follow-up during haemodialysis given the severity of the secondary effects. It has increased the sustained viral response, although it is still less in the population without chronic kidney disease.12 This, along with the difficulty of treating patients with stages 4 and 5 chronic kidney disease in predialysis, highlights the importance of resolving the infection at early kidney disease stages.

Transjugular liver biopsy reduces the risks of bleeding associated with this procedure and the kidney patient, although there is little evidence in the literature.13,14 This technique also allows the hepatic venous pressure gradient to be measured, providing diagnostic and prognostic data.

Studies that determine whether the association of protease inhibitors (telaprevir, boceprevir) with interferon and ribavirin is safe for kidney patients and may increase viral response rates.

Bibliography
[1]
Aoufi Rabih S, García Agudo R. Manejo de la infección por el VHC en la enfermedad renal crónica. Nefrologia 2011;31(3):260-7. [Pubmed]
[2]
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. [Pubmed]
[3]
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. [Pubmed]
[4]
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. [Pubmed]
[5]
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. [Pubmed]
[6]
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. [Pubmed]
[7]
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. [Pubmed]
[8]
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. [Pubmed]
[9]
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. [Pubmed]
[10]
Kamar N, Ribes D, Izopet J, Rostaing L. Treatment of hepatitis C virus infection (HCV) after renal transplantation: implications for HCVpositive dialysis patients awaiting a kidney transplant. Transplantation 2006;82(7):853-6. [Pubmed]
[11]
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. [Pubmed]
[12]
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]
[13]
De Paula Farra K, Carmo RA, De Figueiredo Antunes CM, Serufo JC, Nobre Júnior VA. Hepatitis C, HCV genotypes and hepatic siderosis in patients with chronic renal failure on haemodialysis in Brazil. Nephrol Dial Transplant 2007;22:2027-31. [Pubmed]
[14]
García Agudo R, Aoufi Rabih S, Pérez Roldán F, Guzmán Ames F, González Carro P, Ruiz Carrillo F, Cuesta Domínguez R. El gradiente de presión venoso hepático y la biopsia hepática transyugular en la evaluación de los pacientes con insuficiencia renal y hepatopatía crónica. Nefrologia 2011;31(4):490-2. [Pubmed]
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