Does nocturnal dialysis remove interferon from blood?

Discussions for Patients, Family, and Friends HD For Patients
1

I am on Nocturnal dialysis - 6 nights a week, 7-8 hours each night.

I was diagnosed with Hepatitis C a few months back and have started Interferon therapy.

I was wondering if anyone knew if Pegylated Interferon was cleared out from the blood during 8 hour long hemodialysis sessions.

My doctors are not sure and a search on the internet did not yield anything useful.

I need to take the interferon injection sub cutaneously once a week. My doctor suggested I take it on Saturday morning and skip dialysis on Saturday and Sunday. I’m not sure I need to skip the additional day. If interferon gets removed during dialysis, maybe I do need to skip Saturday and Sunday to let it “act” but if its not removed, I would not like to miss an additional treatment.

Thanks!

2

[quote=kamalshah20;11779]I am on Nocturnal dialysis - 6 nights a week, 7-8 hours each night.

I was diagnosed with Hepatitis C a few months back and have started Interferon therapy.

I was wondering if anyone knew if Pegylated Interferon was cleared out from the blood during 8 hour long hemodialysis sessions.

My doctors are not sure and a search on the internet did not yield anything useful.

I need to take the interferon injection sub cutaneously once a week. My doctor suggested I take it on Saturday morning and skip dialysis on Saturday and Sunday. I’m not sure I need to skip the additional day. If interferon gets removed during dialysis, maybe I do need to skip Saturday and Sunday to let it “act” but if its not removed, I would not like to miss an additional treatment.

Thanks![/quote]

Awhile back I took that therapy, but the older version and was suggested to take it after dialysis. It was a hectic, crazy therapy…side-effects were bad on me, such as hallucinations, just losing my mind and personality!

I see you using the newer version, please let us know your progress on how it goes with you. It will help other patients on dialysis who need it too.

Also, I think its quite a powerful medicine, be careful and try to followup with your Dr. labs can change dramtically with that treatment and dialysis.

Good luck!

3

Thanks Gus, for your reply.

Yes, I am using Pegylated interferon. People usually get Ribavirin too but it is contraindicated in patients with renal failure because it worsens the anemia.

The side effects for me are not that bad at all. I just have mild fever on the day I take the shot and sometimes the next day. Alittle weakness maybe but nothing much more than that. But I guess its different for different people.

My Hemoglobin has fallen from 14.1 before I started the treatment to about 9.5 now (about 12 weeks after I started). My WBC count and Platelet count keep falling. I then take a shot of Neupogen (G-CSF) (about once a week) and they go up again.

My Viral Load when I first did it was about 325,000 copies/ml. I received no treatment apart from Daily nocturnal hemodialysis for about 5 months. The viral load fell to about 42,000.

At this point I started interferon and after 4 weeks of treatment the viral load was 94,000!

So, when I got no treatment, the load fell and when I started getting treatment, it actually increased! I honestly don’t know what to make of this.

I’ve just sent another sample today (at the end of 12 weeks) to check the viral load and will have to wait for about 10 days to get the results.

My doc says he is planning to add another drug - Thymosin alpha if the load does not drop.

This viral load increase is what prompted me to ask if the interferon was not acting because it was getting cleared in the dialysis sessions.

4

[quote=kamalshah20;11781]Thanks Gus, for your reply.

Yes, I am using Pegylated interferon. People usually get Ribavirin too but it is contraindicated in patients with renal failure because it worsens the anemia.

The side effects for me are not that bad at all. I just have mild fever on the day I take the shot and sometimes the next day. Alittle weakness maybe but nothing much more than that. But I guess its different for different people.

My Hemoglobin has fallen from 14.1 before I started the treatment to about 9.5 now (about 12 weeks after I started). My WBC count and Platelet count keep falling. I then take a shot of Neupogen (G-CSF) (about once a week) and they go up again.

My Viral Load when I first did it was about 325,000 copies/ml. I received no treatment apart from Daily nocturnal hemodialysis for about 5 months. The viral load fell to about 42,000.

At this point I started interferon and after 4 weeks of treatment the viral load was 94,000!

So, when I got no treatment, the load fell and when I started getting treatment, it actually increased! I honestly don’t know what to make of this.

I’ve just sent another sample today (at the end of 12 weeks) to check the viral load and will have to wait for about 10 days to get the results.

My doc says he is planning to add another drug - Thymosin alpha if the load does not drop.

This viral load increase is what prompted me to ask if the interferon was not acting because it was getting cleared in the dialysis sessions.[/quote]

I can remember the same happened to me, at initiation of treatment viral load rises temporarily then starts going down steadily. It was really working nice and was near clear, but like many reports on other people who used it the virus returned. Also, when the treatment is stopped its quite scary and dangerous, because the viral load elevates steadily causing liver enzymes to be quite high and that don’t mix well with dialysis. Though I still have the virus it has not caused major problems in my life. Biopsies have shown that my liver is quite well without scarring. It is reported that some people have lived quite a long life regardless they were carriers of HepC…

Anyway, I think its best to give your interferon shot after dialysis, that’s how I did it back then, BUT its better to go by what your Dr. suggests.

Good luck and I hope at the end it turns out as expected…keep us updated!

Happy New Years!

5

Here’s a link to the 2006 Dialysis of Drugs booklet published by National Pharmacy Associates. It includes what is known about the effects of HD and PD on commonly used drugs. Interferon is on this list. It is reportedly not affected by conventional HD or PD, but is affected by certain high permeability dialyzers (defined as KUf >8 mL/hour/mm Hg). I’d suggest that you show this to the doctor that is prescribing your Interferon and to your nephrologist if these are two separate people.
http://www.nephrologypharmacy.com/downloads/DialysisDrugs2006.pdf

6

Thanks so much Beth. I think this is exactly what I was looking for! Now, all I need to do is to check what the KUf of my dialysor is.

7

I have gone through the interferon treatment for a year and I did clear the virus. I have had no reoccurance of the virus and it has been over a year now. My red blood count dropped also. I do not know how dialysis affects the levels, but my final results were good but I was going to clinical dialysis then. One thing I do know is that they wouldn’t put me on the transplant list until I was completed with the interferon therapy. For me soon after I started interferon It caused me a lot of pain from my transplanted kidney’s (I had two transplants still in me at the time) the pain was so bad I had to take both out. The one was in me for 22 years and it became painful and started to cause me to expell blood. So interferon was very hard on my old transplants I would hate to see what it might do to a new one.
For me it worked, but there is no gaurentee that it will not come back after I get another transplant, the drugs can cause reoccurance. I had Hep C 1b, which is said responds well to interferon therapy. It did again I was on 3 times a week clinical dialysis at the time. I just wanted to let you know I went through it and it can work. Wouldn’t want to do it again though low red blood counts and the drug itself can make you feel worse then you already do.

Good Luck!

BruceK
NxStage user since March 06.

8

[quote=Unregistered;11788]I have gone through the interferon treatment for a year and I did clear the virus. I have had no reoccurance of the virus and it has been over a year now. My red blood count dropped also. I do not know how dialysis affects the levels, but my final results were good but I was going to clinical dialysis then. One thing I do know is that they wouldn’t put me on the transplant list until I was completed with the interferon therapy. For me soon after I started interferon It caused me a lot of pain from my transplanted kidney’s (I had two transplants still in me at the time) the pain was so bad I had to take both out. The one was in me for 22 years and it became painful and started to cause me to expell blood. So interferon was very hard on my old transplants I would hate to see what it might do to a new one.
For me it worked, but there is no gaurentee that it will not come back after I get another transplant, the drugs can cause reoccurance. I had Hep C 1b, which is said responds well to interferon therapy. It did again I was on 3 times a week clinical dialysis at the time. I just wanted to let you know I went through it and it can work. Wouldn’t want to do it again though low red blood counts and the drug itself can make you feel worse then you already do.

Good Luck!

BruceK
NxStage user since March 06.[/quote]

One year of therapy, my gawd! I only did 6 months. Did they prescribe any other drugs along with it or just Interferon? Was it the newer Pegylated interferon, once a week shot or the older version?

9

I wish I had this information earlier.

I have been using the F6 HPS dialyser whose kUF is 13 ml/h-mmHg. The file that you sent, Beth says that interferon is not removed if kUF is less than 8.

So, I will switch to the F6 dialyser whose kUF is 5.5.

I guess that could be the reason my viral load is not falling the way it should. As per the data, at the end of 12 weeks of treatment, the viral load should have had a “2 log drop” which means a 100 times less than that at the beginning of treatment. I only got a 1 log drop (10 times less).

I am going to discuss this with my doctor and switch straightaway to the F6 dialyser.

Thanks so much Beth for this information!

Kamal

10

[quote=kamalshah20;11948]I wish I had this information earlier.

I have been using the F6 HPS dialyser whose kUF is 13 ml/h-mmHg. The file that you sent, Beth says that interferon is not removed if kUF is less than 8.

So, I will switch to the F6 dialyser whose kUF is 5.5.

I guess that could be the reason my viral load is not falling the way it should. As per the data, at the end of 12 weeks of treatment, the viral load should have had a “2 log drop” which means a 100 times less than that at the beginning of treatment. I only got a 1 log drop (10 times less).

I am going to discuss this with my doctor and switch straightaway to the F6 dialyser.

Thanks so much Beth for this information!

Kamal[/quote]

I recommend you NOT to switch to an F6 from larger dialyzer like an F80, the consequences are a bit serious. I have done that before and what you will expect is your health going downhill. Blood pressure will go quite high.

As I previously stated in my earlier post, it is suggested to give yourself the shot after dialysis or on days you don’t dialyze, that’s how it was done for me…and I was on an F80…but hey, it doesn’t hurt try how you plan to do it…

Good luck!

11

I am currently using an F6 HPS. Now the pore size of this dialyser is exactly the same as that of an F6 but the number of pores is higher.

I really don’t know what to do.

Since I’m on pegylated interferon, I have to take one shot a week which I usually take on Sunday morning after I come off my nocturnal treatment. I don’t dialyze on Sunday and my next treatment is Monday night. But then I’m getting a lot of dialysis compared to others who are on dialysis and taking interferon.

So, I’m worried that the interferon is being removed from my blood during dialysis because of the high kUF of the F6 HPS. So, I was thinking maybe if I use the F6, this may not happen.

Again, I’ve started using F6 HPS only since I’ve switched to home dialysis. I used F6 when I was in center.

Thoughts?

Thanks
Kamal

12

[quote=kamalshah20;11955]I am currently using an F6 HPS. Now the pore size of this dialyser is exactly the same as that of an F6 but the number of pores is higher.

I really don’t know what to do.

Since I’m on pegylated interferon, I have to take one shot a week which I usually take on Sunday morning after I come off my nocturnal treatment. I don’t dialyze on Sunday and my next treatment is Monday night. But then I’m getting a lot of dialysis compared to others who are on dialysis and taking interferon.

So, I’m worried that the interferon is being removed from my blood during dialysis because of the high kUF of the F6 HPS. So, I was thinking maybe if I use the F6, this may not happen.

Again, I’ve started using F6 HPS only since I’ve switched to home dialysis. I used F6 when I was in center.

Thoughts?

Thanks
Kamal[/quote]

Its a tough call, I think its best to go by your Dr.'s orders or suggestion. When I did that therapy I was in-center 3x a week.

Just maybe another option is to switch temporarily to daily-short and see if that helps, but talk to your Dr about your concerns.

13

Is there any documented evidence that your Hep C values have changed to indicate that the interferon may be being cialyzed off or are you concerned that it may change in the future?

14

There is no evidence to confirm this but the file you sent the link of says that interferon is not removed only if the kUF of the dialyser is less than 8 ml/h-mmHg.

And usually people who take the interferon treatment for my type of Hep C clear the virus at the end of 12 weeks. But again, this is not always true. The drug works better on some people than others. But I just want to rule out the possibility of the interferon being cleared during dialysis.

Thanks
Kamal

15

If some of the interferon is dialyzed off with larger dialyzers, I’d suggest talking the doctor about what dose of interferon would be needed to compensate for the amount reduced during dialysis and/or how long you need to dialyze on the lower coefficient dialyzer. You don’t want to shortchange your dialysis. Here’s an article from 1999 that describes dialyzers, dialysis prescription and adequacy of dialysis. Search for KUf to read what it says about this measure.
http://cnserver0.nkf.med.ualberta.ca/cn/Schrier/Volume5/ch6/ADK5-06_4-6.ccc.QXD.pdf

16

[QUOTE=Unregistered;11788]I have gone through the interferon treatment for a year and I did clear the virus. I have had no reoccurance of the virus and it has been over a year now. My red blood count dropped also. I do not know how dialysis affects the levels, but my final results were good but I was going to clinical dialysis then. One thing I do know is that they wouldn’t put me on the transplant list until I was completed with the interferon therapy. For me soon after I started interferon It caused me a lot of pain from my transplanted kidney’s (I had two transplants still in me at the time) the pain was so bad I had to take both out. The one was in me for 22 years and it became painful and started to cause me to expell blood. So interferon was very hard on my old transplants I would hate to see what it might do to a new one.
For me it worked, but there is no gaurentee that it will not come back after I get another transplant, the drugs can cause reoccurance. I had Hep C 1b, which is said responds well to interferon therapy. It did again I was on 3 times a week clinical dialysis at the time. I just wanted to let you know I went through it and it can work. Wouldn’t want to do it again though low red blood counts and the drug itself can make you feel worse then you already do.

Good Luck!

BruceK
NxStage user since March 06.[/QUOTE]

The same thing happened to my husband. He was on peg- interferon for 12months, also had a previous transplant that wasn’t working and this transplant ended up necrotic in him, he almost died from that. The doctor had a hard time removing it because it was completely rotten and falling apart.
He was very sick on the interferon and dialysis at the same time, he blood count and platelets were so low he was very sick. The treatment in the end didn’t work. :frowning: He still has hepC- genotype 1b, hard to get rid of, but also the slowest disease progressive one. they didnt allow him on the transplant list while using interferon also.

Would you have another kidney transplant, knowing you have hepC and getting immunosuppressed again might increase the chances of the liver disease progressing? We have been told that this is likely and might cause problems with liver failure. My husband is listed for another kidney transplant which he would do in a heart beat, but I am very concerned about the possible outcome. All be it, it is his choice and I respect that.

cheers Queenie.

17

Here, different people say different things with regard to a transplant. Some doctors say that it is better to get rid of the HCV before a transplant. some doctors say HCV is not a contraindication for a renal transplant.

I have another complication and I’ve sent a blood sample to the UK for a test that will determine if a transplant will work out or not because of some genetic factors in my case.

So, once I get a response from them, I will start thinking about a transplant.

Thanks for your response Queenie!

Kamal

18

I switched to an F6 dialyser and seem to be doing well. No perceptible change in how I feel or my labs.

Since my viral load was not falling as it should, the thinking is to change the type of interferon from Pegintron to Pegasys.

Now it could be a possibility that the Pegintron I was taking was getting cleared during my nocturnal dialysis sessions. So, I switched to F6 which does not clear interferon. Its only 2.5 weeks since I made the switch.

So, I’m wondering if I should wait for another 1.5 weeks (to make a total of 4 weeks of using F6) and then do a viral load to check if there is a good drop. For all you know Pegintron may be right for me but not acting well enough because it was not allowed to stay in the body long enough.

If, after another 1.5 weeks, the viral load has not yet dropped significantly, I can switch to Pegasys.

Advice?

19

[QUOTE=kamalshah20;12631]Since my viral load was not falling as it should, the thinking is to change the type of interferon from Pegintron to Pegasys.

If, after another 1.5 weeks, the viral load has not yet dropped significantly, I can switch to Pegasys.

Advice?[/QUOTE]

Hi Kamal,
My husband used pegasys, but he just got the 2log drop, they did allow him to continue for the full 12 months of treatment. Still at the end of 12months treatment he didn’t clear the virus and he also had a necrotic transplant kidney to be removed. :slight_smile: I don’t think he will try the interferon again.

They have suggested he try a transplant that is hepC positive, although this is new in our country. We are skeptical and have many questions. Have you heard of anything like this.

hope it works out for you.
Queenie.

20

No Queenie, I have not heard of being transplanted with a Hep C person’s kidney.