Cholongitas Evangelos, Pipili Chrysoula, Papatheodoridis George V
Evangelos Cholongitas, 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece.
World J Hepatol. 2017 Feb 8;9(4):180-190. doi: 10.4254/wjh.v9.i4.180.
Treatment of patients with chronic kidney disease (CKD) and chronic hepatitis C (CHC) differs from that used in the general CHC population mostly when glomerular filtration rate (GFR) is below 30 mL/min, as sofosbuvir, the backbone of several current regimens, is officially contraindicated. Given that ribavirin free regimens are preferable in CKD, elbasvir/grazoprevir is offered in CHC patients with genotype 1 or 4 and ombitasvir/paritaprevir and dasabuvir in genotype 1b for 12 wk. Although regimens containing peginterferon with or without ribavirin are officially recommended for patients with CKD and genotype 2, 3, 5, 6, such regimens are rarely used because of their low efficacy and the poor safety and tolerance profile. In this setting, especially in the presence of advanced liver disease, sofosbuvir-based regimens are often used, despite sofosbuvir contraindication. It seems to have good overall safety with only 6% or 3.4% of CKD patients to discontinue therapy or develop serious adverse events without drug discontinuation. In addition, sustained virological response (SVR) rates with sofosbuvir based regimens in CKD patients appear to be comparable with SVR rates in patients with normal renal function. Treatment recommendations for kidney transplant recipients are the same with those for patients with CHC, taking into consideration potential drug-drug interactions and baseline GFR before treatment initiation. This review summarizes recent data on the current management of CHC in CKD patients highlighting their strengths and weaknesses and determining their usefulness in clinical practice.
慢性肾脏病（CKD）合并慢性丙型肝炎（CHC）患者的治疗与普通CHC人群不同，主要体现在肾小球滤过率（GFR）低于30 mL/min时，因为几种现有治疗方案的核心药物索磷布韦被官方列为禁忌。鉴于在CKD患者中无利巴韦林的治疗方案更可取，对于基因1型或4型的CHC患者可使用艾尔巴韦/格拉瑞韦，对于基因1b型患者可使用奥比他韦/帕利瑞韦和达沙布韦治疗12周。尽管官方推荐含聚乙二醇干扰素（无论有无利巴韦林）的方案用于CKD合并基因2、3、5、6型的患者，但由于其疗效低且安全性和耐受性差，此类方案很少使用。在这种情况下，尤其是存在晚期肝病时，尽管索磷布韦有禁忌，基于索磷布韦的治疗方案仍经常被使用。它似乎具有良好的总体安全性，只有6%或3.4%的CKD患者停药或在不停药的情况下发生严重不良事件。此外，CKD患者中基于索磷布韦的治疗方案的持续病毒学应答（SVR）率似乎与肾功能正常患者的SVR率相当。肾移植受者的治疗建议与CHC患者相同，需考虑治疗开始前潜在的药物相互作用和基线GFR。本综述总结了近期关于CKD患者CHC当前管理的数据，突出了它们的优缺点，并确定了它们在临床实践中的实用性。
