Interferon treatment in hemodialysis patients with chronic hepatitis C virus infection: a systematic review of the literature and meta-analysis of treatment efficacy and harms

Am J Kidney Dis. 2008 Feb;51(2):263-77. doi: 10.1053/j.ajkd.2007.11.003.


Background: Hepatitis C virus (HCV) infection is prevalent in patients undergoing hemodialysis and is associated with greater mortality. We determined the efficacy and harms of interferon (IFN) and pegylated IFN (PEG-IFN) treatment of hemodialysis patients with chronic HCV infection and identified factors associated with these outcomes.

Study design: Meta-analysis and meta-regression of randomized controlled trials, uncontrolled trials, and prospective observational studies.

Setting & population: Hemodialysis patients with chronic HCV infection.

Selection criteria for studies: MEDLINE indexed studies since 1966, sample size greater than 10.

Intervention: IFN-based treatment, including PEG-IFN with and without ribavirin.

Outcomes: Sustained virological response (SVR) 6 months after treatment, rate of treatment discontinuation caused by adverse events, and factors associated with these outcomes.

Results: 20 studies of 459 IFN-treated patients, 3 studies of 38 PEG-IFN-treated patients, and 2 studies of 49 PEG-IFN and ribavirin-treated patients met inclusion criteria. The overall SVR rate was 41% (95% confidence interval [CI], 33 to 49) for IFN and 37% (95% CI, 9 to 77) for PEG-IFN. Treatment discontinuation rates were 26% (95% CI, 20 to 34) for IFN and 28% (95% CI, 12 to 53) for PEG-IFN. SVR was higher with 3 million units (MU) or higher of IFN 3 times weekly, with lower mean HCV RNA, and with lower rates of cirrhosis, HCV genotype 1 or elevated transaminase, but these findings were not statistically significant. Treatment discontinuation rates were greater in studies using larger doses.

Limitations: Publication bias, few randomized controlled trials, and limitations in generalizability to all hemodialysis patients.

Conclusion: IFN treatment of hemodialysis patients results in an SVR rate of 41%. Higher dose, lower mean HCV RNA level, and lower rates of cirrhosis, transaminase level increase, and HCV genotype 1 may be associated with greater SVR rates, but additional studies using individual patient data are needed.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Female
  • Hemodiafiltration* / adverse effects
  • Hepacivirus / drug effects
  • Hepacivirus / genetics
  • Hepacivirus / isolation & purification*
  • Hepatitis C, Chronic / drug therapy*
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use
  • Interferons / adverse effects
  • Interferons / therapeutic use*
  • Male
  • Middle Aged
  • Polyethylene Glycols / therapeutic use
  • RNA, Viral / isolation & purification
  • Randomized Controlled Trials as Topic
  • Recombinant Proteins
  • Research Design
  • Treatment Outcome
  • Viral Load / methods


  • Antiviral Agents
  • Interferon alpha-2
  • Interferon-alpha
  • RNA, Viral
  • Recombinant Proteins
  • Polyethylene Glycols
  • Interferons
  • peginterferon alfa-2a