Author Interview: Dr. Craig Gordon
|
Publication:
Author Interview: Dr. Craig Gordon
Long-Term Viral Negativity After Interferon for Chronic Hepatitis C Virus Infection in Hemodialysis.
Gordon CE, Uhlig K, Schmid CH, Levey AS, Wong JB.
Department of Medicine, Boston University Medical Center, Boston, Massachusetts;
Clin J Am Soc Nephrol. 2011 Jul 22.
|
What are the main findings of the study? |
We found through a systematic review of the literature and meta-analysis that most hepatitis C virus infected patients undergoing hemodialysis who are successfully treated with interferon or pegylated-interferon-based treatment and achieved sustained virological response (hepatitis C virus negative 6 months after treatment) remain viral negative after four years of followup or longer. Importantly, this long-term viral negativity occured in patients who remained on hemodialysis and those who later underwent kidney transplantation, in spite of the possibility that immunosuppression could lead to a viral relapse.
|
Were any of the findings unexpected? |
These findings were not necessarily expected because the assumption is that hepatitis C virus treatment is less effective in dialysis patients, so this is an important finding that not only do hemodialysis patients have reasonably high rates of clearing the virus, but that about 90% of patients will remain viral negative for 4 years or longer. This is comparable to the rates seen in the general population.
|
What should clinicians and patients take away from this study? |
Treatment of hepatitis C virus should be considered in hemodialysis patients who are otherwise in reasonably good health and good treatment candidates and particularly in kidney transplant candidates.
We should be cautious, however, with how we interpret the study because dialysis patients have higher rates of side effects from the treatment and some patients are not good candidates for treatment, so the treatment is not for everyone. The decision needs to be individualized between patients, their nephrologists and likely hepatologists, who often are the doctors prescribing hepatitis C virus treatment.
Additionally, we don't have evidence if successful HCV treatment in dialysis patients results in improved clinical outcomes like survival and liver disease-related complications.
Finally, the study was a meta-analysis of published studies which always runs the risk that only successful treatment studies are published, so we may be overestimating how effective the treatment is.
|
What recommendations do you have for nephrology health care providers as a result of your study? |
Treatment of hepatitis C virus should be considered in hemodialysis patients who are otherwise in reasonably good health and good treatment candidates and particularly in kidney transplant candidates but the decision needs to be individualized to the specific clinical situation for each patient. Treatment should be planned in conjunction with hepatologists.
|
| Abstract: |
Summary Background and objectives Interferon (IFN) and pegylated-IFN treatment of hepatitis C virus (HCV) infection in hemodialysis patients result in sustained virological response (SVR) rates of 45% and 37%, respectively. Although most nonhemodialysis patients who achieve SVR remain persistently viral negative, the durability of SVR in hemodialysis patients is unknown.
We analyzed the rate of long-term virological negativity in hemodialysis patients who achieved SVR after IFN or pegylated-IFN through analysis of patient-level data. Design, setting, participants, & measurements After performing a systematic literature review for IFN-based treatment of hemodialysis patients with chronic HCV infection, we extracted patient-level data on patients who achieved SVR. We performed life table analysis to estimate long-term virological negativity rates after SVR in patients who continued on hemodialysis or subsequently underwent kidney transplantation.
Results Long-term HCV RNA outcomes following SVR were available for 121 hemodialysis patients (20 studies) and 45 patients who subsequently underwent transplantation (11 studies). The probability of remaining HCV RNA negative was 86% (95% confidence interval, 77% to 96%) for patients followed on hemodialysis 48 months after SVR and 95% (95% confidence interval, 89% to 100%) for kidney recipients followed 48 months after transplant.
Conclusions Viral negativity from IFN-based HCV treatment in hemodialysis patient appears durable during extended follow-up, including after kidney transplantation. The certainty of the viral negativity estimate is limited by the small number with follow-up beyond 48 months or longer. Transplantation does not confer an increased risk of relapse. Future research should investigate whether IFN-based treatment improves clinical outcomes for hemodialysis patients.outcomes for hemodialysis patients.
|
| More Author Interview from Hemodialysis.com |
| More on Hepatitis and Liver Disease in CKD and Hemodialysis Patients |
Author Interviews: hemodialysis
- Dialysis - ESRD - CKD |
| One-Year Assessment of Quality Indicators in Acute Dialysis Program Operated by a Large Dialysis Provider |
| Characteristics of patients most likely to have a missed Dialysis session |
| More Frequent HB measurements & ESA titrations not Associated with Inreased Time in Target HB range |
Study Shows Daily Home Hemodialysis Patients More Likely to Receive Kidney Transplant
Difference in KidneyTransplant Incidence with Daily Home Hemodialysis vs. Thrice-Weekly Dialysis |
| Characterizing Missed Dialysis Sessions in the ESRD Patient population |
| Hemoglobin Recovery following Hospitalization in ESRD patients |
| Association of Serum Sodium Levels with Mortality in Non-Dialysis Dependent Chronic Kidney Disease |
| Talking Control Support in Hemodialysis Results in Higher Patient Satisfaction Survey Response |
| Use of Fondparinux in Severe Renal Impairment & Hemodialysis |
| Contribution of CA, phosphorus & 25-VitD to the excessive severity of sPTH in African-Americans with CKD |
| Comparison of Risk Prediction Using the CKD-EPI Equation & the MDRD Study Equation for eGFR |
| Iron-Based Phosphate Binder PA21: Effective and Well Tolerated in CKD Hemodialysis Patients |
| Hemoglobin Recovery following Hospitalization in ESRD patients |
| Disease Management Program ESRD Patients Have Lower Overall Medical Costs |
Crit-Line Monitor Use in Incident Hemodialysis Patients Improves Dry Weight and Adequacy,
While Reducing Epoetin Alfa Dose: A Propensity Score Matched Study |
| Perceptions & Roles of Nephrology Social Worker Within the Suicide Continuum of Care |
| Reduced Use of ESAs and IV Iron with Ferric Citrate: A Medicare Bundle Cost-Offset Model |
| Video Education Increases Patient Knowledge About Phosphorus Control |
| Effect of a plasma sodium biofeedback system applied to HFR on the intradialytic cardiovascular stability |
| Hemodialysis Access and Age-related Postoperative Outcomes: Which Fistula First? |
| Coronary Artery Calcification & Pre-Hemodialysis Bicarbonate Levels in Hemodialysis |
| Protein/omega-3 supplementation during regular dialysis sessions & inflammatory indices in hemodialysis |
| VDRA and improved survival in dialysis patients with serum intact PTH ≤150 pg/mL |
| Relation of social support to mental health and locus of control in Chronic Kidney Disease |
| Depression and anxiety in patients with chronic renal failure |
| Self -esteem in Greek dialysis patients: The contribution of health locus of control |
| Medication adherence in Greek hemodialysis patients: Contribution of depression and health cognition. |
| Association of insomnia with kidney disease quality of life reported by patients on maintenance dialysis |
| Comorbidities/ inactivity & long-term outcomes of CABG in small number of men on chronic hemodialysis |
| Complete Recovery From Acute Kidney Injury With Incident CKD Stage 3 and All-Cause Mortalit |
| Outcomes of patients with ESRD under chronic hemodialysis requiring CRRT & in AKI requiring CRRT |
| Radiologically Placed Tunneled Hemodialysis Catheters: Pediatric Institutional Experience of 120 Patients |
| Preload dependence of gated cardiac SPECT-derived ventricular volumes in hemodialysis |
| Effect of Hemoglobin Target on Progression of Kidney Disease |
| eGFR at Reinitiation of Dialysis & Mortality in Failed Kidney Tranplant Recipients |
| Biomarkers Determining Cardiovascular Risk in Kidney Disease |
| Rural and Micropolitan Residence & Mortality in Dialysis |
| Urinalysis is more specific & urinary NGAL is more sensitive for early AKI detection |
| Vascular Klotho Deficiency Potentiates Development of Arterial Calcification & Mediates FGF23 Resistance |
| Efficacy of preventing hemodialysis catheter infections with citrate lock: Hemodialysis Int'l |
| Learn about dialysis options from a Home Dialysis Therapy Nurse |
| Optimal fluid control can normalize CV risk markers and limit LV hypertrophy in thrice weekly dialysis |
| LDL, atherosclerosis and mortality in hemodialysis |
| Pulmonary hypertension in chronic kidney disease on dialysis/ without dialysis |
| Predictors of steal syndrome in hemodialysis Hemodialysis Int'l |
| Sodium intake and blood pressure in renal transplant recipients Nephrology Dialysis Transplant |
| HIV-associated nephropathy patients with & without apolipoprotein L1 gene variants Kidney International |
| Depression and nonadherence predict mortality in hemodialysis treated ESRD patients Hemodialysis Int'l |
| Serum Metabolite Concentrations and Decreased GFR in the General Population AJKD |
| High Volume Peritoneal Dialysis in Acute Kidney Injury CJASN |
| Trial of Catheters of Different Lengths to Achieve Right Atrium vs SVC Placement for CRRT AJKidneyDs |
Pre-kidney transplant ESA agence responsiveness with post-transplant outcomes
Nephrology Dialysis Transplant |
| Prognostic Value of 48-Hour Ambulatory BP & CV Mortality in Hemodialysis Kidney Blood Press Res |
| Darbepoetin-α Cardiovascular Geometry and CKD -Cardiorenal Med |
| Influenza Vaccine Effectiveness in Patients on Hemodialysis Arch Intern Med |
| Bioelectrical Impedance Analysis & Skinfold Thickness Sum in Body Fat Mass in Dialysis J.Renal Nutrition |
| Pre-Diabetes after Renal Transplantation Nephrology Dialysis Transplant |
| Essential trace element status and clinical outcomes in long-term dialysis |
| End-of-Life Decision-Making Confidence in Surrogates of AA Dialysis Patients Is Overly Optimistic |
| Comparison of Cardiac PET Perfusion Defects During Stress Induced by Hemodialysis vs Adenosine AJKD |
| Mental Health over Time & Cardiac Outcomes in HEMO Study CJASN |
| Cholesterol Synthesis, Cholesterol Absorption, & Mortality in Hemodialysis CJASN |
| Statins, Risk & Outcome in Acute Kidney Injury in Community-Acquired Pneumonia CJASN |
| Dialysis-Dependent Changes in Ventricular Repolarization |
| High Burden of Kidney Disease in Youth-Onset Type 2 Diabetes Diabetes Care |
| Late Start Dialysis & Outcomes in Japanese Dialysis: Therapeutic Apheresis & Dialysis |
| Pica in Pediatric Dialysis - J.Renal Nutrition |
| Elemental Concentrations in Scalp Hair in Hemodialysis Patients Therapeutic Apheresis & Dialysis |
Health-related QOL was not improved by targeting higher hemoglobin in the Normal Hematocrit Trial
Kidney Int'l |
| Sevelamer on HbA1c, Inflammation, & Advanced Glycation End Products in Diabetic Kidney Disease CJASN |
| Increasing organ donation via anticipated regret proposed protocol |
| Statins on Chronic Inflammation and Nutrition status in Renal Dialysis |
| Emergency Department Use of Urinary Biomarkers of Nephron Damage |
| Preemptive renal transplant survival, access to care, & renal function at listing Nephrology Dialysis Transplant |
| Effect of Diuretic Use on 30-Day Postdialysis Mortality in Critically Ill Patients Receiving Acute Dialysis Dr. Ko |
| FGF23 predicts incident cardiovascular event before but not after the start of dialysis Dr. Isaka |
| Mortality Prediction by Surrogates of Body Composition: An Examination of the Obesity Paradox in Hemodialysis Using Composite Ranking Score Analysis: Drs. Miklos Z Molnar & Kamyar Kalantar-Zadeh |
| Plasma Sodium & Blood Pressure in Hemodialysis J.Human Hypertension |
| Increased Risk of Death in Young African American Dialysis Patient: Dr. Norman |
| Nutritional Management of Stage 5 CKD J. Renal Nutrition |
A proposed management algorithm for fistulae between hemodialysis access circuits and adjacent veins
Vasc Access |
| Percutaneous approach in maintenance & salvage of dysfunctional autologous vascular access for dialysis |
| The Kidney Disease Quality of Life Cognitive Function Subscale and Cognitive Performance in Maintenance Hemodialysis Patients Amer. J Kidney Diseases |
| Absolute Interdialytic Weight Gain is more important than Percent Weight Gain for Intradialytic Hypotension in heavy hemodialysis patients: Dr. Chen Nephrology |
| Postdialysis BP rise predicts outcomes in hemodialysis: Dr Yang BMC Nephrology |
| APOL1 allelic variants are associated with lower age of dialysis initiation Nephrology Dialysis Transplant |
| Effects of Six versus Three Times per Week Hemodialysis on Physical Performance, Health, and Functioning: Frequent Hemodialysis Network (FHN) Randomized Trials Dr. Hall CJASN |
| Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk Dr. Di Iorio |
| Assessment of Body Composition Using Dry Mass Index and Ratio of Total Body Water to Estimated Volume Based on Bioelectrical Impedance Analysis in CKD J. Renal Nutrition |
| Potential Role of Active Vitamin D Treatment in Telomere Length in Hemodialysis: Dr Valdivielso |
| CKD, severe arterial & arteriolar sclerosis & kidney neoplasia MELAS syndrome Dr. Piccoli BMC Nephrology |
| Pedometer-Assessed Physical Activity in Children and Young Adults with CKD |
| Effect of Frequent or Extended Hemodialysis on Cardiovascular Parameters Amer J. Kidney Ds |
| Exposure to bisphenol A is associated with low-grade albuminuria in Chinese adults Dr. Guang Kidney Int'l |
| Increased dietary sodium and greater mortality in hemodialysis Kidney Int'l |
| Sonography Characteristics of the Intra-Dialysis-Graft Thrombus Dr. Cheng |
Featured Hemodialysis Interviews |
Home Dialysis Summit Recommends Policy Changes to Increase Home Dialysis Usage
WASHINGTON, April 25, 2012 /PRNewswire -- On the heels of the first National Summit on Home Dialysis Policy, Summit organizers released a report reflecting the views of the delegates -- leaders in the kidney disease patient, clinician, facility and industry communities -- on federal policy steps to improve utilization of home dialysis for patients who can benefit from this often advantageous form of treatment. Many of the organizers also announced they have formed a new alliance, called the Alliance for Home Dialysis, to advance the recommendations identified at the Summit.
The Summit's "Report of the Delegates" highlights key findings from a March 29th meeting in Washington, DC where experts probed why, despite widely accepted and well-documented benefits of home dialysis -- improved outcomes, enhanced patient satisfaction, improved quality of life, and lower costs-- fewer than ten percent of the more than 390,000 current U.S. dialysis patients receive treatment at home. Current rates of home dialysis utilization reflect a steep decline from the 1970s, when almost 40% of U.S. dialysis patients were treated in-home.
Specifically, delegates found that policymakers should work with stakeholders in the dialysis community to confront three areas:
Accessibility: Patients and clinicians face array of hurdles in education, training, and infrastructure that hinder equalized access to home dialysis.
Accountability: Utilization of home dialysis can be improved through measures within government programs that are designed to recognize and support excellence in the delivery of home dialysis services.
Aligning Incentives: Reimbursement policies, regulation of new technologies and other policy incentives can be realigned to better support federal policy goals of expanding access to home dialysis.
The Report includes 15 recommendations to serve these goals, including that federal policymakers should:
Maintain parity for home and in-center dialysis in Medicare reimbursement;
Support home dialysis mentoring programs, particularly those that use existing patients as mentors; and
Align federal and state regulatory requirements for home therapies, such as revising the Centers for Medicare and Medicaid Services Conditions for Coverage requirements, to reflect differences in home and in-center dialysis.
Summit supporters will begin work through the new Alliance to dialogue with federal policymakers and advance policy improvements in the three consensus areas that emerged at the Summit.
SOURCE National Summit on Home Dialysis Policy
|
| |
National Kidney Foundation's Top 10 Things Every Dialysis Patient Should Know.
- You have treatment choices. Options exist for how, where and when you dialyze. Dialysis can be done in a hospital, in a dialysis unit that is not part of a hospital, or at home. You and your doctor will decide which place is best, based on your medical condition and your wishes. There are different types of dialysis - peritoneal and hemodialysis. Work with your health care team to determine a treatment plan that makes you feel comfortable. Recent studies show that the majority of patients beginning in-center hemodialysis (HD) know very little, if anything, about the option to dialyze at home. Once informed, 40% or more of patients are interested in this treatment option, and yet less than 10% actually begin home dialysis. If you're dissatisfied with the type of dialysis treatment that you're receiving, ask your healthcare team if another type of dialysis treatment would be better.
- You can compare in-center dialysis facilities online. Information on over 5,600 US-based dialysis centers is available online through the Medicare website. To help you make choices about your care, you can compare different facilities side-by-side and evaluate each facility based upon clinic characteristics and quality measures. You can search for dialysis facilities by name or geographic proximity. After completing an initial facility comparison to determine which facilities best meet your needs - such as the number of hemodialysis stations at a particular location and whether there are evening shifts available - visit the facilities that you're most interested in. Talk to the staff and other patients, as well as your doctor to ensure that this dialysis facility is a good fit for you.
- There are ways to prepare ahead for an emergency. Ask your dialysis facility about their emergency plan in case of a snow storm, fire, power outage or other natural disaster. As back up, make sure you have the names, locations and phone numbers of other dialysis units and hospitals in your area. Since regular community transportation services may not be working in an emergency, be prepared to make other arrangements for getting to dialysis. You may need to contact the police and Emergency Medical Services (EMS) for assistance. If you dialyze at home, make sure you have at least two weeks' worth of unexpired supplies on hand. If you have to miss a dialysis treatment, begin your emergency meal plan.
- There is an easy way to transfer patient records between clinics. There is an easy, secure way for your health care team to transfer your treatment records online. In 2009, the Centers for Medicare and Medicaid Services (CMS) created a centralized web-based data collection system called CROWNWeb to help reduce and eliminate patient treatment interruptions. This central system helps to streamline patient care regardless of the reason for changing dialysis centers. For example, if you've been admitted to the hospital, or if you needed to relocate during an emergency evacuation, your doctors and health care team can access up-to-date information about your dialysis so that you continue to receive appropriate care no matter where you are.
- You can travel while on dialysis.
Dialysis centers are located in every part of the United States and in many foreign countries. The treatment is standardized, but you need to plan ahead by making an appointment for dialysis at another center before you go. The staff at your center may help you make these appointments.
- You can be your own best advocate. Know what key questions to ask your doctor or other healthcare professionals. Take notes so that you can refer back to them later. Partner with your doctor and decide on a treatment plan together. Advocate for yourself and share how you're feeling.
- You have many rights. You as a patient have a great deal of control over your treatments. Patients have a bill of rights which includes receiving quality care, counseling about your medical information, and an expectation of privacy.
You also have responsibilities. Once you decide on a course of treatment, it's important to follow the recommendations of your health care team. If you decide to receive in-center dialysis, arrive at dialysis on time so that you can receive the full treatment without delays.
- You can receive insurance coverage. If you have end stage renal failure, you are likely eligible for Medicare insurance coverage. Speak with your health care team and social worker for help filling out insurance paperwork.
- You may need to follow a special diet. When your kidneys are not working properly, you may not be able to eat everything you like, and you may need to limit how much you drink. Your diet may vary according to the type of dialysis you receive. It is important to speak with a renal dietitian so that you are able to understand what you can and cannot eat based on your full health history.
- Dialysis patients can work. Many dialysis patients can go back to work or school after they have gotten used to dialysis. After establishing a dialysis routine, many patients have more energy and find that they are able to time to work around this new schedule. Some patients even find creative ways to work remotely from dialysis with the use of a laptop or cell phone, depending on their field of expertise.
More from National Kidney Foundation Press Releases
|
|
New Book to Help Educate Patients with Chronic Kidney Disease who may be facing Dialysis or Hemodialysis: |
Help, I Need Dialysis!
How to have a good future with kidney disease
By Dori Schatell, MS and Dr. John Agar
An internationally known nephrologist and life-long kidney patient educator explain how dialysis works, each of the ways to do it, and how your treatment choice may affect your diet, energy level, work, travel, sexuality and fertility, sleep, and survival. Comprehensive and fully referenced, this book is a must-read if you face the life-changing choices that come with kidney failure. |
|
|
