Hepatitis C in patients with renal disease



==Recommendations for Treatment of Patients with Kidney Disease: AASLD Practice Guidelines 2009 == 1. All persons with chronic kidney disease awaiting renal replacement therapy, namely hemodialysis or kidney transplantation, should be screened for hepatitis C in order to plan for management and treatment (Class I, Level B).

2. The decision to perform a liver biopsy in patients with kidney disease should be individualized, based upon the clinical assessment for the need for therapy and the need to establish the severity of the liver disease (Class IIa, Level C).

3. Persons with chronic HCV infection and mild kidney disease (GFR >60 mL/minute) can be treated with the same combination antiviral therapy as that used in persons without kidney disease (Class IIa, Level C).

4. Persons with chronic HCV infection and severe kidney disease not undergoing hemodialysis can be treated with reduced doses of both peginterferon (alpha-2a, 135 μg/week; alpha 2b, 1 μg/kg/week) and ribavirin (200-800 mg/day) with careful monitoring for adverse effects (Class IIa, Level C).

5. Treatment of HCV in patients on dialysis may be considered with either standard interferon (2a or 2b) in a dose of 3 mU t.i.w. or reduced dose pegylated interferon 2a, 135 ug/week or 2b 1 ug/kg/week. (Class IIa, level C). Ribavirin can be used in combination with interferon in a markedly reduced daily dose with careful monitoring for anemia and other adverse effects. (Class IIb, level C).

6. Treatment is not recommended for patients with chronic HCV infection who have undergone kidney transplantation, unless they develop ﬁbrosing cholestatic hepatitis (Class III, Level C).

7. Patients with cryoglobulinemia and mild to moderate proteinuria and slowly progressive kidney disease can be treated with either standard interferon or reduced doses of pegylated interferon alfa and ribavirin (Class IIa, Level C).

8. Patients with cryoglobulinemia and marked proteinuria with evidence of progressive kidney disease or an acute ﬂare of cryoglobulinemia can be treated with rituximab, cyclophosphamide plus methylprednisolone, or plasma exchange followed by interferon-based treatment once the acute process has subsided (Class IIa, Level C).