title: Treatment of hepatitis C virus infection in patients on maintenance hemodialysis: a single United Arab Emirates center experience.
abstract: BACKGROUND
  Hepatitis C is prevalent among hemodialysis patients. In patients with normal kidney function, treatment with pegylated interferon and ribavirin can lead to eradication of HCV (hepatitis C virus). But the treatment is more problematic in patients with impaired kidney function, in part due to the altered pharmacokinetics of these medications. Despite recent guidelines, the optimal strategy in this group of patients is not well defined.
  
  
  METHODS
  In a retrospective study, we reviewed all patients with chronic hepatitis C on hemodialysis treated at Sheikh Khalifa Medical City, in the United Arab Emirates between 2003 and 2009. The aim of our study was to determine the rate of sustained viral response (SVR) and to establish the safety and rate of dropouts in the different treatment regimens used (patients treated with peginterferon only and patients treated with peginterferon and low dose ribavirin).
  
  
  RESULTS
  22 patients were treated during this period. 5 patients received monotherapy with a reduced dose of peginterferon alfa 2b s.c. once weekly while 17 patients were treated with a combination of reduced dose of peginterferon alfa 2a or 2b s.c. once weekly and a low dose ribavirin (200mg/day). A SVR was achieved in 73% (16/22 patients) of the total patient population and in 76% (13/17 patients) in the sub-group of patients treated with a combination therapy. The tolerability was high. No patients had to discontinue their treatment. The use of ESA (erythropoietin stimulating agents) and G-CSF was common in the combination therapy (94% and 53% respectively).
  
  
  CONCLUSIONS
  In our study of patients on hemodialysis with chronic hepatitis C, the use of peginterferon or a combination of peginterferon with a low daily dose of ribavirin achieved a high rate of SVR and the rate of dropout was low after pursuing an aggressive management of side effects.
authors.affiliation: Sheikh Khalifa Medical City, Division of Gastroenterology, Abu Dhabi, UAE. alagiguere@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Giguere
authors.forename: A
authors.initials: A
authors.lastname: Anas
authors.forename: T
authors.initials: T
authors.lastname: Nasser
authors.forename: M H
authors.initials: MH
authors.lastname: Hassan
authors.forename: U
authors.initials: U
authors.lastname: Ahmed
authors.forename: N
authors.initials: N
authors.lastname: Beejay
authors.forename: M
authors.initials: M
authors.lastname: Nouh
authors.forename: M
authors.initials: M
authors.lastname: Khalowf
authors.forename: A
authors.initials: A
authors.lastname: Saleh
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: M
authors.initials: M
authors.lastname: Attia
authors.forename: G
authors.initials: G
authors.lastname: El-Azab
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D006435:Renal Dialysis; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D014479:United Arab Emirates
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b; C100416:peginterferon alfa-2a