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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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Table 1.
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 |
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