KDIGO-Leitlinien - Hepatitis C: Prävention, Diagnose, Evaluation und Behandlung bei chronischer Nierenerkrankung

Abstract

Dialysis patients are at risk of acquiring viral hepatitis C during treatment. The KDIGO guideline evaluates published evidence and suggests relevant measures for screening and detection of the infection in patients with CKD. These patients may or may not be treated with antivirals based on an individual decision. CKD patients often discontinue interferon treatment due to side effects. If tolerated, the results are comparable to persons with normal renal function. Ribavirin is contraindicated with a GFR below 50 ml/min. Prevention of nosocomial transmission is based on rigorous standard hygienic precautions. Hand hygiene of the dialysis staff is of utmost importance. Single use gloves should be worn, all equipment and surfaces should be adequately cleaned and disinfected. In contrast to current German hygiene guidelines for dialysis treatment, the KDIGO guideline does no longer recommend to use separate dialysis machines for HCV infected patients. Both guidelines do not require separate treatment rooms. The discrepancy arises from differences in risk assessment based on the same literature. Since KDIGO sets worldwide minimum standards, local guidelines may still define higher security levels. Chronic hepatitis C is not necessarily a contraindication against renal transplantation. Antiviral treatment can be tried to improve the patient's individual prognosis. However, even without treatment or when treatment remains unsuccessful, kidney transplantation may be performed in selected patients. Immunosuppressive therapy does usually not lead to decompensation of the viral infection. Nevertheless, follow-up assessment should include liver function and the possible development of post-transplant diabetes.