Management of patients with hepatitis C infection and renal disease  

作　　者：Chalermrat Bunchorntavakul Monthira Maneerattanaporn Disaya Chavalitdhamrong 

机构地区：[1]Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University [2]Division of Gastroenterology and Hepatology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University [3]Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Florida, Gainesville

出　　处：《World Journal of Hepatology》2015年第2期213-225,共13页世界肝病学杂志（英文版）（电子版）

摘　　要：Hepatitis C virus(HCV) infection in patients with end-stage renal disease(ESRD) is associated with more rapid liver disease progression and reduced renal graft and patients' survival following kidney transplantation. Evaluations and management of HCV in patients with renal disease are challenging. The pharmacokinetics of interferons(IFN), ribavirin(RBV) and some direct acting antiviral(DAA), such as sofosbuvir, are altered in patients with ESRD. With dose adjustment and careful monitoring, treatment of HCV in patients with ESRD can be associated with sustained virological response(SVR) rates nearly comparable to that of patients with normal renal function. DAA-based regimens, especially the IFNfree and RBV-free regimens, are theoretically preferred for patients with ESRD and KT in order to increase SVR rates and to reduce treatment side effects. However, based on the data for pharmacokinetics, dosing safety and efficacy of DAA for patients with severe renal impairment are lacking. This review will be focused on the evaluations, available pharmacologic data, and management of HCV in patients with severe renal impairment, patients who underwent KT, and those who suffered from HCV-related renal disease, according to the available treatment options, including DAA.Hepatitis C virus （HCV） infection in patients with endstagerenal disease （ESRD） is associated with morerapid liver disease progression and reduced renal graftand patients＇ survival following kidney transplantation.Evaluations and management of HCV in patients withrenal disease are challenging. The pharmacokineticsof interferons （IFN）, ribavirin （RBV） and some directacting antiviral （DAA）, such as sofosbuvir, are altered inpatients with ESRD. With dose adjustment and carefulmonitoring, treatment of HCV in patients with ESRD canbe associated with sustained virological response （SVR）rates nearly comparable to that of patients with normalrenal function. DAA-based regimens, especially the IFNfreeand RBV-free regimens, are theoretically preferredfor patients with ESRD and KT in order to increase SVRrates and to reduce treatment side effects. However,based on the data for pharmacokinetics, dosing safetyand efficacy of DAA for patients with severe renalimpairment are lacking. This review will be focusedon the evaluations, available pharmacologic data, andmanagement of HCV in patients with severe renalimpairment, patients who underwent KT, and thosewho suffered from HCV-related renal disease, accordingto the available treatment options, including DAA.

关 键 词：HEPATITIS C Renal disease Chronic kidneydisease DIALYSIS INTERFERON Direct ACTING ANTIVIRALS CRYOGLOBULINEMIA 

分 类 号：R512.63[医药卫生—内科学] R692[医药卫生—临床医学]