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  • 1 University of Debrecen, Medical and Health Science Center 2nd Department of Medicine, Division of Gastroenterology Nagyerdei krt. 98 H-4032 Debrecen Hungary
  • 2 University of Debrecen, Medical and Health Science Center 1st Department of Medicine, Division of Nephrology Nagyerdei krt. 98 H-4032 Debrecen Hungary
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The prevalence of hepatitis C virus infection among patients on hemodialysis is about ten times higher than in the normal population. The infection can induce chronic glomerulonephritis, as an extrahepatic manifestation, which can lead to end-stage renal disease. However, in the majority of patients hepatitis C virus is acquired as a nosocomial infection during hemodialysis. Most of the infected patients have usually normal liver enzymes and need regular screening for hepatitis C antibody to detect the infection. Despite the normal liver enzymes, the liver disease may progress to cirrhosis. Some of the patients are on the renal transplantation waiting list. The immunosuppressive treatment after renal transplantation results in a significantly increased viral replication which might induce further progression of the liver disease. Interferon treatment given after transplantation can induce rejection and graft failure. Therefore the antiviral treatment should be administered during or before the hemodialysis period. Only limited data are available about the treatment of patients with impaired renal function. Alfa-interferon was used mostly in these patients. Due to its impaired renal clearance and higher serum concentration interferon seems to be more effective, but less tolerable in patients with end-stage renal disease than in other groups of patients. Ribavirin is also excreted exclusively by the kidney with anemia being even more pronounced in these patients, and as such is contraindicated in patients on hemodialysis. The pharmacokinetics of the pegylated interferon alfa-2a is very advantageous for patients with end-stage renal disease. The safety and efficacy of peginterferon alfa-2a is now being confirmed in many publications.

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