HCV and CKD

[wife2R]

Hi. I just found this site and it looks great. My husband has HCV and CKD. His neph says the kidney problem is caused by the HCV, but last year he had one of his kidneys removed because of cancer. So I wonder. My real concern is that R. won't be able to take the HCV meds because I often read that it's very bad for the kidneys, and he's only got one that's in bad shape. Found the HCV accidentally and we think he's had it for over 30 years. Also, 30 years of alcohol abuse until his surgery last Aug. Sometimes I feel like there's no hope.

[wife2R]

thank you, mike for the good info!
and thank you, nygirl7, for the hope!
yes, R. has a very reputable hepatologist at Vanderbilt, who was at the Mayo Clinic for a long time. He wants to do a liver biopsy before treatment begins. And he's talked about transplantation. It's difficult, though, to get info from the doctors! I know they don't have time to answer my millions of questions. It's frustrating. But I'm so glad to have found this site! Thanks again.
wife2R  

[mikesimon]

I am not aware that impaired renal function precludes treatment for HCV. I have read  that kidney disease is a negative predictor of SVR but, so too are a lot of conditions yet people have overcome them. I have seen articles which discuss the plasma levels of ribavirin with renal impaired patients. The suggestion is that rather than weight base dose these patients the dose should be arrived at by considering GFR (glomerular filtration rate).

This is from Clinical Care Options @ http://tiny.cc/mNYPW

"Summary of Key Conclusions

    * Dosing according to glomerular filtration rate (GFR) may be preferable to weight-based ribavirin among ribavirin-treated HCV genotype 1/4 patients with poor renal function
    * Poor renal function (low GFR) associated with
          o Lower sustained virologic response (SVR) rates
          o More adverse events
          o Possibly due to nonoptimal ribavirin dosing
    * GFR varied according to sex, age, and genotype but not according to weight or body mass index (BMI)
    * Further studies needed to determine if adjusting ribavirin according to GFR would improve treatment response

Background

    * Ribavirin treatment currently dosed according to body weight, but weight-based ribavirin possibly not optimal dosing regimen
    * Current study conducted to determine utility of dosing ribavirin according to GFR in patients with chronic HCV infection
    * Evaluated influence of GFR on ribavirin treatment
          o SVR
          o Tolerability
          o Dose adjustment"

The point is, with renal impairment the standard weight based ribavirin dose may not be the best approach in patients with kidney disease. I would bring this up with his doctor before starting treatment and try to get a game plan to deal with this issue.

Mike

[nygirl7]

I'm sorry I don't know the answer to that question but I didn't want you to think that nobody is answering you.  I can't remember ever seeing this discussed before and I"ve been on this forum for three years.

There are some very smart people on here and I will try and flag a couple of them to get a response.

There is hope honey.  They are working on new drugs constantly now - they've realized just HOW MANY Americans have this disease and don't even know it.  The percentage is absolutely staggering but since most people don't develop symptoms until very very late in the game...they just go about life.

Have you spoken to a reputable heptologist? One that is very current in the new trials and procedures going on?  If not regular treatment than he might know of a trial that is promising and be able to help get him enrolled in that.