Management of hepatitis C in patients with chronic kidney disease
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNIFESP |
Texto Completo: | http://dx.doi.org/10.3748/wjg.v21.i2.408 http://repositorio.unifesp.br/handle/11600/38636 |
Resumo: | Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. the vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. in hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. in KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. in these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. in these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus. |
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Management of hepatitis C in patients with chronic kidney diseaseHepatitis C virusChronic kidney diseaseEnd-stage renal diseaseHemodialysisKidney transplantationDiagnosisConservative managementTherapyHepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. the vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. in hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. in KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. in these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. in these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus.Universidade Federal de São Paulo, Div Gastroenterol, Hepatol Sect, BR-04023900 São Paulo, BrazilUniversidade Federal de São Paulo, Div Gastroenterol, Hepatol Sect, BR-04023900 São Paulo, BrazilWeb of ScienceBaishideng Publishing Group IncUniversidade Federal de São Paulo (UNIFESP)Carvalho-Filho, Roberto José de [UNIFESP]Feldner, Ana Cristinade Castro Amaral [UNIFESP]Silva, Antonio Eduardo Benedito [UNIFESP]Ferraz, Maria Lucia G. [UNIFESP]2016-01-24T14:39:54Z2016-01-24T14:39:54Z2015-01-14info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion408-422http://dx.doi.org/10.3748/wjg.v21.i2.408World Journal of Gastroenterology. Pleasanton: Baishideng Publishing Group Inc, v. 21, n. 2, p. 408-422, 2015.10.3748/wjg.v21.i2.4081007-9327http://repositorio.unifesp.br/handle/11600/38636WOS:000348419200004engWorld Journal of Gastroenterologyinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2023-03-27T16:28:17Zoai:repositorio.unifesp.br/:11600/38636Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652023-03-27T16:28:17Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false |
dc.title.none.fl_str_mv |
Management of hepatitis C in patients with chronic kidney disease |
title |
Management of hepatitis C in patients with chronic kidney disease |
spellingShingle |
Management of hepatitis C in patients with chronic kidney disease Carvalho-Filho, Roberto José de [UNIFESP] Hepatitis C virus Chronic kidney disease End-stage renal disease Hemodialysis Kidney transplantation Diagnosis Conservative management Therapy |
title_short |
Management of hepatitis C in patients with chronic kidney disease |
title_full |
Management of hepatitis C in patients with chronic kidney disease |
title_fullStr |
Management of hepatitis C in patients with chronic kidney disease |
title_full_unstemmed |
Management of hepatitis C in patients with chronic kidney disease |
title_sort |
Management of hepatitis C in patients with chronic kidney disease |
author |
Carvalho-Filho, Roberto José de [UNIFESP] |
author_facet |
Carvalho-Filho, Roberto José de [UNIFESP] Feldner, Ana Cristinade Castro Amaral [UNIFESP] Silva, Antonio Eduardo Benedito [UNIFESP] Ferraz, Maria Lucia G. [UNIFESP] |
author_role |
author |
author2 |
Feldner, Ana Cristinade Castro Amaral [UNIFESP] Silva, Antonio Eduardo Benedito [UNIFESP] Ferraz, Maria Lucia G. [UNIFESP] |
author2_role |
author author author |
dc.contributor.none.fl_str_mv |
Universidade Federal de São Paulo (UNIFESP) |
dc.contributor.author.fl_str_mv |
Carvalho-Filho, Roberto José de [UNIFESP] Feldner, Ana Cristinade Castro Amaral [UNIFESP] Silva, Antonio Eduardo Benedito [UNIFESP] Ferraz, Maria Lucia G. [UNIFESP] |
dc.subject.por.fl_str_mv |
Hepatitis C virus Chronic kidney disease End-stage renal disease Hemodialysis Kidney transplantation Diagnosis Conservative management Therapy |
topic |
Hepatitis C virus Chronic kidney disease End-stage renal disease Hemodialysis Kidney transplantation Diagnosis Conservative management Therapy |
description |
Hepatitis C virus (HCV) infection is highly prevalent among chronic kidney disease (CKD) subjects under hemodialysis and in kidney transplantation (KT) recipients, being an important cause of morbidity and mortality in these patients. the vast majority of HCV chronic infections in the hemodialysis setting are currently attributable to nosocomial transmission. Acute and chronic hepatitis C exhibits distinct clinical and laboratorial features, which can impact on management and treatment decisions. in hemodialysis subjects, acute infections are usually asymptomatic and anicteric; since spontaneous viral clearance is very uncommon in this context, acute infections should be treated as soon as possible. in KT recipients, the occurrence of acute hepatitis C can have a more severe course, with a rapid progression of liver fibrosis. in these patients, it is recommended to use pegylated interferon (PEG-IFN) in combination with ribavirin, with doses adjusted according to estimated glomerular filtration rate. There is no evidence suggesting that chronic hepatitis C exhibits a more aggressive course in CKD subjects under conservative management. in these subjects, indication of treatment with PEG-IFN plus ribavirin relies on the CKD stage, rate of progression of renal dysfunction and the possibility of a preemptive transplant. HCV infection has been associated with both liver disease-related deaths and cardiovascular mortality in hemodialysis patients. Among those individuals, low HCV viral loads and the phenomenon of intermittent HCV viremia are often observed, and sequential HCV RNA monitoring is needed. Despite the poor tolerability and suboptimal efficacy of antiviral therapy in CKD patients, many patients can achieve sustained virological response, which improve patient and graft outcomes. Hepatitis C eradication before KT theoretically improves survival and reduces the occurrence of chronic graft nephropathy, de novo glomerulonephritis and post-transplant diabetes mellitus. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-01-14 2016-01-24T14:39:54Z 2016-01-24T14:39:54Z |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.3748/wjg.v21.i2.408 World Journal of Gastroenterology. Pleasanton: Baishideng Publishing Group Inc, v. 21, n. 2, p. 408-422, 2015. 10.3748/wjg.v21.i2.408 1007-9327 http://repositorio.unifesp.br/handle/11600/38636 WOS:000348419200004 |
url |
http://dx.doi.org/10.3748/wjg.v21.i2.408 http://repositorio.unifesp.br/handle/11600/38636 |
identifier_str_mv |
World Journal of Gastroenterology. Pleasanton: Baishideng Publishing Group Inc, v. 21, n. 2, p. 408-422, 2015. 10.3748/wjg.v21.i2.408 1007-9327 WOS:000348419200004 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
World Journal of Gastroenterology |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
408-422 |
dc.publisher.none.fl_str_mv |
Baishideng Publishing Group Inc |
publisher.none.fl_str_mv |
Baishideng Publishing Group Inc |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UNIFESP instname:Universidade Federal de São Paulo (UNIFESP) instacron:UNIFESP |
instname_str |
Universidade Federal de São Paulo (UNIFESP) |
instacron_str |
UNIFESP |
institution |
UNIFESP |
reponame_str |
Repositório Institucional da UNIFESP |
collection |
Repositório Institucional da UNIFESP |
repository.name.fl_str_mv |
Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP) |
repository.mail.fl_str_mv |
biblioteca.csp@unifesp.br |
_version_ |
1814268454600966144 |