Kidney disease in patients with chronic liver disease

Article information

J Korean Med Assoc. 2020;63(1):14-19

Publication date (electronic) : 2020 January 17

doi : https://doi.org/10.5124/jkma.2020.63.1.14

Jae Hyun Chang, 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

Revised 2019 October 4; Accepted 2019 November 25.

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.

Keywords: Chronic disease; Liver diseases; Hepatitis B virus; Hepatitis C virus; Kidney diseases

Table 1.

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

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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
ESRD^b)	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.

^a)

Recommended only for nucleoside/nucleotide analog-naïve patients.

^b)

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