Hepatitis C in patients with chronic kidney disease: Course and management

The prevalence of chronic hepatitis C (CHC) is significantly higher in patients with end-stage renal disease undergoing hemodialysis than in the general population. CHC adversely affects survival in patients on hemodialysis and those who have undergone renal transplantation (RT); routine screening for hepatitis C virus infection is recommended for both groups. Treatment of CHC in post-RT patients and those undergoing hemodialysis remains challenging. Data on nonpegylated interferon alfa and pegylated interferon alfa monotherapies remain limited, and treatment-induced adverse effects are common. Ribavirin is contraindicated in these patients, but a combination of low-dose ribavirin with interferon is being assessed in clinical trials. Further studies are needed to clarify the pathogenesis and natural history of CHC in hemodialysis patients and post-RT patients and to develop effective treatment for hepatitis C virus infection in these patients.