jkma Journal of the Korean Medical Association J Korean Med Assoc 1975-8456 2093-5951 Korean Medical Association 10.5124/jkma.2020.63.1.14 jkma-63-14 Focused Issue of this Month Kidney disease in patients with chronic liver disease ChangJae Hyun MD Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea Corresponding author: Jae Hyun Chang E-mail: jhchang@gilhospital.com 12020 1712020 631 1419 4102019 25112019 Copyright © 2020 Korean Medical Association 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

The kidneys are closely connected with several organs, including the liver, and can therefore be negatively affected when the liver is damaged. The most common cause of chronic liver disease is chronic viral hepatitis, resulting from either a hepatitis B virus (HBV) or a hepatitis C virus (HCV). Chronic viral hepatitis often progresses to cirrhosis and hepatocellular carcinoma. However, it can also lead to viral-associated glomerulopathies that can cause chronic kidney disease (CKD), which can then progress to end stage renal disease (ESRD). Additionally, patients with ESRD on hemodialysis are at risk for viral infections because HBV and HCV are hematogenously transmitted. Recently, treatments with oral nucleoside/nucleotide analogues and direct-acting antivirals have yielded excellent results in HBV- and HCV-infected patients with CKD. As a result, a new paradigm for the treatment of chronic viral infections in CKD patients has emerged. This review discusses viral-associated glomerulopathies, antiviral treatments of HBV and HCV infections in patients with CKD, and prevention strategies for the transmission of HBV and HCV in patients with ESRD.

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Dosage adjustments of nucleoside/nucleotide analogues for hepatitis B according to serum CrCl

CrCl (mL/min) Lamivudine Telbivudine Entecavir a) Adefovir Tenofovir DF Tenofovir AF Besifovir
≥50 100 mg/day 600 mg/day 0.5 mg/day 10 mg/day 300 mg/day 25 mg/day 150 mg/day
30-49 100 mg first dose, then 50 mg/day 600 mg/day 2 0.25 mg/day or 0.5 mg/day 2 10 mg/day 2 300 mg/day 2 25 mg/day No recommendation
15-29 100 mg first dose, then 25 mg/day 600 mg/day 3 0.15 mg/day or 0.5 mg/day 3 10 mg/day 3 300 mg/day 3-4 25 mg/day No recommendation
10-14 35 mg first dose, then 15 mg/day 600 mg/day 3 0.15 mg/day or 0.5 mg/day 3 10 mg/day 3 300 mg/day 3-4 No recommendation No recommendation
ESRDb) 35 mg first dose, then 10 mg/day (CrCl < 5 mL/min) 600 mg/day 4 0.05 mg/day or 0.5 mg/day 7 10 mg/day 7 300 mg/day 7 No recommendation No recommendation

CrCl, creatinine clearance; DF, disoproxil fumarate; AF, alafenamide fumarate; ESRD, end stage renal disease.

Recommended only for nucleoside/nucleotide analog-naïve patients.

In patients undergoing hemodialysis, all agents should be given after hemodialysis.