Management of HCV in Dialysis Patients

HCV infection remains frequent among patients on maintenance haemodialysis, and HCV has a detrimental role on survival in this population. Recent data have been accumulated on the antiviral treatment of HCV in dialysis patients. Although response rates to conventional interferon are better in the dialysis population, tolerance to interferon monotherapy appears lower in patients on maintenance haemodialysis than in the population with intact kidney function. The most frequent side effects requiring interruption of treatment were flu-like symptoms and gastrointestinal and haematological changes. One-third of dialysis patients with chronic HCV were successfully treated with conventional or pegylated interferon monotherapy, the summary estimate for sustained virological response rate being 39% (95% CI 32, 46) and 31% (95% CI 7, 55), respectively, according to a recent meta-analysis. Preliminary evidence does not support additional benefit of monotherapy with peginterferon on the viral response in the dialysis population. Scarce data exist on combined antiviral therapy for HCV (interferon plus ribavirin) in the dialysis population, even if encouraging results in terms of viral response have been noted. The optimal antiviral treatment of chronic hepatitis C in the dialysis population is currently under investigation.