Management of hepatitis C in patients with chronic kidney disease

Table 1 Studies on acute hepatitis C treatment in hemodialysis patients

Ref.	Süleymanlar et al[26] (1998)	Gürsoy et al[27] (2001)	Urbánek et al[28] (2004)	Al-Harbi et al[29] (2005)	Rocha et al[30](2007)	Engel et al[32](2007)	Liu et al[33](2010)	Ferreira et al[31] (2011)
n	3	36	18	9	23	10	35	26
Interferon type	IFN	IFN	IFN	IFN	IFN	PEG-IFN α2b	PEG-IFN α2a	IFN
								PEG-IFN α2a
Schedule	4.5 MU tiw	3 MU or	10 MU +	3 MU tiw	3 MU or	1 μg/kg qw	135 μgv qw	3 MU tiw
		6-10 MU tiw	3 MU tiw		6 MU tiw			or 135 μg qw
Duration	16 wk	12 wk	3 wk + 12 wk	12 wk	48 or 24 wk	24 wk	24 wk	48 wk
SVR	100%	39%	72%	67%	43%	40%	89%	54%

IFN: Interferon; PEG-IFN: Pegylated interferon; MU: Million units; tiw: Three times a week; qw: Once a week; SVR: Sustained virological response rate by intention-to-treat analysis.

Table 2 Treatment regimens for hepatitis C virus infection in chronic kidney patients

Stage of CKD	Estimated GFR	Target dosage of ribavirin	Dosage of Interferon
1	≥ 90	800 to 1200 mg qd1	PEG-IFN α2a 180 μg qw or PEG-IFN α2b 1.5 μg/kg qw
2	60 to 89	600 to 800 mg qd1
3	30 to 59	400 to 600 mg qd1
4	15 to 29	200 mg qd	PEG-IFN α2a 135 μg qwor PEG-IFN α2b 1.0 μg/kg qw
5	< 15 or HD	Titrated according to patient tolerability2

¹Divided in two doses;

²See text for details. GFR: Glomerular filtration rate expressed in mL/min per 1.73 m²; qd: Once a day; PEG-IFN: Pegylated interferon; qw: Once a week; HD: Hemodyalisis.

Table 3 Meta-analyses on the treatment of chronic hepatitis C in hemodialysis patients

Ref.	Year	Trials (n)	Therapy	n	SVR1
Russo et al[95]	2003	11	IFN	213	33% (21%-51%)
Fabrizi et al[96]	2003	14	IFN	269	37% (28%-48%)
Gordon et al[97]	2008	20	IFN	459	41% (33%-49%)
		5	PEG-IFN	87	37% (9%-77%)
Fabrizi et al[99]	2008	24	IFN	529	39% (32%-46%)
		4	PEG-IFN	116	31% (7%-55%)
Gordon et al[98]	2009	20	IFN	428	45%
Alavian et al[100]	2010	21	IFN	491	39% (32%-46%)
		12	PEG-IFN	279	39% (27%-52%)
Fabrizi et al[101]	2010	16	PEG-IFN	254	33% (24%-43%)
Fabrizi et al[102]	2011	10	PEG-IFN + RBV	151	56% (28%-84%)
Fabrizi et al[103]	2014	11	PEG-IFN + RBV	287	60% (28%-97%)

¹Mean overall estimate for sustained virological response (range). IFN: Interferon; PEG-IFN: Pegylated interferon; RBV: Ribavirin.

Table 4 Studies on the treatment of chronic hepatitis C in kidney transplant recipients

Ref.	Year	n	Therapy	Interferon dose	Duration (mo)	SVR
Harihara et al[154]	1994	3	IFN	3-6 MU biw	NA	NA
Therret et al[155]	1994	13	IFN	3-5 MU tiw	About 4	NA
Magnone et al[156]	1995	11	IFN	1.5-5.0 MU tiw	6	NA
Rostaing et al[157]	1995	14	IFN	3 MU tiw	About 5	0%
Ozgür et al[158]	1995	5	IFN	4.5 MU tiw	6	NA
Yasumura et al[159]	1997	6	IFN	6 MU tiw	About 7	33%
Durlik et al[160]	1998	11	IFN	3 MU tiw	About 6	0%
Hanafusa et al[161]	1998	10	IFN	9 MU tiw	6	10%
Tokumoto et al[162]	1998	6	IFN	9 MU tiw	6	50%
Baid et al[163]	2003	12	IFN + RBV	3 MU tiw	Variable	33%
Tang et al[164]	2003	4	IFN + RBV	3 MU tiw	12	50%
Shu et al[165]	2004	11	IFN + RBV	1 MU tiw	12	27%
Izopet et al[166]	1997	15	IFN	3 MU tiw	About 5	0%
Sharma et al[167]	2006	6	IFN + RBV	3 MU tiw	About 12	33%
Pageaux et al[168]	2009	8	PEG-IFNα2a	180 μg qw	6-12	50%
Aljumah et al[169]	2012	19	PEG-IFN + RBV	90-180 μg qw	12	42%
Sanai et al[170]	2013	32	PEG-IFN + RBV	135-180 μg qw	12	38%

IFN: Interferon; MU: Million units; biw: Two times a week; NA: Not available; tiw: Three times a week; PEG-IFN: Pegylated interferon; RBV: Ribavirin; SVR: Sustained virological response rate by intention-to-treat analysis.