Lens Sabela, Rodriguez-Tajes Sergio, Llovet Laura-Patricia, Maduell Francisco, Londoño Maria-Carlota
Liver Unit, CIBERehd, Hospital Clínic Barcelona, IDIBAPS, Barcelona, Spain.
Dig Dis. 2017;35(4):339-346. doi: 10.1159/000456585. Epub 2017 May 3.
There is a strong relationship between hepatitis C virus (HCV) infection and the kidney. Approximately 10-16% of the patients with HCV infection develop renal disease, and the prevalence of HCV infection in patients with renal dysfunction is higher than that of the general population (9.5 vs. 1.6%). Moreover, HCV-positive patients on hemodialysis (HD) have higher mortality rates as compared to HCV-negative patients also on HD, not only due to liver-related complications but also owing to cardiovascular disease. Key Messages: In the interferon era, the treatment of HCV infection in patients on HD was hampered due to a significant number of treatment-related adverse events (predominately anemia and infectious complications). The development of direct-acting antivirals (DAAs) has revolutionized the field allowing viral eradication in these very sick patients. Two recently published clinical trials assessed the efficacy and safety of DAAs in patients with end-stage renal disease (ESRD). The combination of grazoprevir and elbasvir has been studied in the C-SURFER trial with 94% of the patients achieving sustained virological response (SVR). Adverse events were mild and only a small number of patients discontinued therapy early due to adverse events. The 3D regimen was evaluated in the RUBY-I trial. Here, a 90% SVR rate was achieved in 20 patients with ESRD, most of them on HD. Although sofosbuvir is eliminated by the kidney and its use in patients with glomerular filtration rate <30 mL/min is not recommended, real-life data have shown good results for this drug in terms of efficacy and safety.
The use of DAAs has safely permitted the treatment of patients with renal dysfunction with excellent efficacy results.
丙型肝炎病毒（HCV）感染与肾脏之间存在密切关系。约10%-16%的HCV感染患者会发展为肾脏疾病，肾功能不全患者中HCV感染的患病率高于普通人群（9.5%对1.6%）。此外，与同样接受血液透析（HD）的HCV阴性患者相比，HCV阳性的HD患者死亡率更高，这不仅是由于肝脏相关并发症，还因为心血管疾病。关键信息：在干扰素时代，HD患者的HCV感染治疗因大量与治疗相关的不良事件（主要是贫血和感染并发症）而受阻。直接抗病毒药物（DAAs）的出现彻底改变了这一领域，使这些病情严重的患者能够实现病毒清除。最近发表的两项临床试验评估了DAAs在终末期肾病（ESRD）患者中的疗效和安全性。在C-SURFER试验中研究了格卡瑞韦和艾尔巴韦的联合用药，94%的患者实现了持续病毒学应答（SVR）。不良事件较轻，只有少数患者因不良事件提前停药。在RUBY-I试验中评估了3D方案。在此试验中，20例ESRD患者（大多数接受HD）的SVR率达到90%。虽然索磷布韦经肾脏排泄，不建议在肾小球滤过率<30 mL/min的患者中使用，但实际临床数据显示该药物在疗效和安全性方面都取得了良好结果。
DAAs的使用已安全地实现了对肾功能不全患者的治疗，疗效优异。
