Recently, Berenguer1 reviewed anti–hepatitis C virus treatment in hemodialysis (HD) patients.
The aim for hepatitis C virus–positive HD patients who are candidates for kidney transplant is a sustained viral response. This response persisting after transplantation leads to a better prognosis of both the renal graft and liver.2, 3
There are two pegylated interferon (Peg-IF) molecules (Peg-IF alfa 2a and Peg-IF alfa 2b), and they have different absorption and distribution profiles.4 HD clears each of them at a different rate. The recommended dose of Peg-IF alfa 2a in patients with a creatinine clearance of less than 20 mL/minute is 135 μg/week. To the best of our knowledge, there are no reported dosing recommendations for Peg-IF alfa 2b in HD patients.
Data balancing the pros and cons of treatment are necessary. Limitations in applicability to HD patients have been pointed out. We suggest that more research is needed and that several factors should be considered when studies on efficacy and safety in HD are being designed:
The type of Peg-IF is important, as is the risk of adding ribavirin.
The dialysis technique (peritoneal versus HD) has an effect on the pharmacokinetics of interferon alpha.