Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN).

Salvatore Petta,Vincenzo Montinaro,Francesco Perticone,Marcello Persico,Anna Linda Zignego,Antonio Chirianni,Maria Rendina,Edoardo G. Giannini,Massimo Puoti,Fabrizio Fabrizi,Loreto Gesualdo,Giovanni Raimondo,Roberto Minutolo,Paolo Maggi,Ernesto Paoletti,Alessio Aghemo

doi:10.1007/s40620-018-0523-1

Abstract

Hepatitis C virus (HCV) infection is now considered a systemic disease due to the occurrence of extra-hepatic manifestations. Among these, the renal involvement is frequent. HCV infection, in fact, is strongly associated with proteinuria and chronic kidney disease (CKD) and negatively affects the prognosis of renal patients. In the last few years, availability of more specific and effective drugs against HCV has dramatically changed the clinical course of this disease. These drugs may provide further advantages in the CKD population as a whole by reducing progression of renal disease, mortality rate and by increasing the survival of graft in renal transplant recipients. The strict pathogenetic and prognostic link between HCV infection and CKD requires an ongoing relationship among the healthcare professionals involved in the treatment of both HCV infection and CKD. Therefore, Scientific Societies involved in the care of this high-risk population in Italy have organized a joint expert panel. The aim of the panel is to produce a position statement that can be used in daily clinical practice for the management of HCV infected patients across the whole spectrum of renal disease, from the conservative phase to renal replacement treatments (dialysis and transplantation). Sharing specific evidence-based expertise of different professional healthcare is the first step to obtain a common ground of knowledge on which to instate a model for multidisciplinary management of this high-risk population. Statements cover seven areas including epidemiology of CKD, HCV-induced glomerular damage, HCV-related renal risk, staging of liver disease in patients with CKD, prevention of transmission of HCV in hemodialysis units, treatment of HCV infection and management of HCV in kidney transplantation.

Highlights

Chronic hepatitis C virus (HCV) infection is a leading cause of chronic liver disease and is considered as a public health concern with a worldwide prevalence rate of 1–2%
It is widely accepted that HCV infection predisposes to the onset of chronic kidney disease (CKD); it worsens the prognosis of renal patients by increasing the risk of endstage renal disease (ESRD) and mortality in non-dialysis CKD patients, mortality rate in hemodialysis patients and loss of graft in kidney transplant recipients
The Kidney Disease Improving Global Outcome (KDIGO) HCV Work Group had already recommended that all CKD patients be tested for HCV [88]; we suggest that in hemodialysis units initial testing by immunoassay should be considered; if positive, immunoassay must be followed by nucleic acid testing (NAT)

Summary

Introduction

Chronic hepatitis C virus (HCV) infection is a leading cause of chronic liver disease and is considered as a public health concern with a worldwide prevalence rate of 1–2%. HCV can promote atherogenesis through several direct and indirect biological mechanisms including arterial inflammation, insulin resistance, liver steatosis, oxidative stress, hyperhomocysteinemia, and greater production of tumor necrosis factor-alpha [102,103,104] All this findings support a close monitoring of renal damage over time (mainly by eGFR and albuminuria) in order to detect patients with earlier and faster progression of renal disease. A large observational cohort study involving more than one million of veterans, has evidenced that patients with positive to HCV (10% of cohort) had a doubled risk of starting dialysis and a 22% higher probability of having a faster progression of renal disease (GFR loss > 5 mL/min/year) [105].

Conclusion

Findings

Compliance with ethical standards