Abstract
Hepatitis C virus infection is still common among dialysis patients, but the natural history of HCV in this group is not completely understood. Recent evidence has been accumulated showing that anti-HCV positive serologic status is significantly associated with lower survival in dialysis population; an increased risk of liver and cardiovascular disease-related mortality compared with anti-HCV negative subjects has been found. According to a novel meta-analysis (fourteen studies including 145,608 unique patients), the adjusted RR for liver disease-related death and cardiovascular mortality was 3.82 (95% CI, 1.92; 7.61) and 1.26 (95% CI, 1.10; 1.45), respectively. It has been suggested that the decision to treat HCV in patients with chronic kidney disease be based on the potential benefits and risks of therapy, including life expectancy, candidacy for kidney transplant, and co-morbidities. According to recent guidelines, the antiviral treatment of choice in HCV-infected patients on dialysis is mono-therapy but fresh data suggest the use of modern antiviral approaches (i.e., pegylated interferon plus ribavirin). The summary estimate for sustained viral response and drop-out rate was 56% (95% CI, 28–84) and 25% (95% CI, 10–40) in a pooled analysis including 151 dialysis patients on combination antiviral therapy (conventional or pegylated interferon plus ribavirin).
Highlights
Hepatitis C virus (HCV) infection remains frequent in patient receiving long-term dialysis both in developed and lessdeveloped countries. e natural history of HCV infection in dialysis patients remains incompletely understood; controversy continues even in patients with intact kidney function
Recent evidence indicates that HCV plays a detrimental effect on survival in the dialysis population, but it remains unknown whether the elevated mortality risk because of HCV infection is only attributable to an increase in liver disease-related deaths
The available data that critically evaluate the indications for treatment and determine the most efficacious and safe treatment protocols in CKD patients are limited. e KDIGO work group suggested that all CKD patients with HCV infection be evaluated for antiviral treatment. e decision to treat HCV infection in the CKD patients should be based on the potential bene ts and risks of therapy, including life expectancy, candidacy for kidney transplantation, and comorbidities. e patients should be appropriately informed of the risks and bene ts of antiviral therapy and should participate in the decision-making process
Summary
Hepatitis C virus (HCV) infection remains frequent in patient receiving long-term dialysis both in developed and lessdeveloped countries. e natural history of HCV infection in dialysis patients remains incompletely understood; controversy continues even in patients with intact kidney function. Hepatitis C virus (HCV) infection remains frequent in patient receiving long-term dialysis both in developed and lessdeveloped countries. E natural history of HCV infection in dialysis patients remains incompletely understood; controversy continues even in patients with intact kidney function. Assessing the natural history of hepatitis C among patients on regular dialysis is even more problematic because of additional characteristics of this population. Aminotransferase activity is lower in patients with chronic renal failure than in nonuremic population, and this may hamper recognition of HCV-related liver disease. Recent evidence indicates that HCV plays a detrimental effect on survival in the dialysis population, but it remains unknown whether the elevated mortality risk because of HCV infection is only attributable to an increase in liver disease-related deaths
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