Abstract
Prevalence rates of HCV infection are decreasing in hemodialysis units of most developed countries; however, nosocomial transmission of HCV continues to occur in the hemodialysis setting, not only in the emerging world. According to the Dialysis Outcomes and Practice Patterns Study (DOPPS, 2012–2015), the prevalence of HCV among patients on regular hemodialysis was 9.9%; in incident patients, the frequency of HCV was approximately 5%. Outbreaks of HCV have been investigated by epidemiologic and phylogenetic data obtained by sequencing of the HCV genome; no single factor was retrieved as being associated with nosocomial transmission of HCV within hemodialysis units. Transmission of HCV within HD units can be prevented successfully by full compliance with infection control practices; also, antiviral treatment and serologic screening for anti-HCV can be useful in achieving this aim. Infection control practices in hemodialysis units include barrier precautions to prevent exposure to blood-borne pathogens and other procedures specific to the hemodialysis environment. Isolating HCV-infected hemodialysis patients or using dedicated dialysis machines for HCV-infected patients are not currently recommended; reuse of dialyzers of HCV-infected patients should be made, according to recent guidelines. Randomized controlled trials regarding the impact of isolation on the risk of transmission of HCV to hemodialysis patients have not been published to date. At least two studies showed complete elimination of de novo HCV within HD units by implementation of strict infection control practices without isolation practices. De novo HCV within hemodialysis units has been independently associated with facility HCV prevalence, dialysis vintage, and low staff-to-patient ratio. Antiviral treatment of HCV-infected patients on hemodialysis should not replace the implementation of barrier precautions and other routine hemodialysis unit procedures.
Highlights
Liver damage is relatively common in patients with chronic kidney disease, those on regular dialysis and kidney transplant recipients
These findings initially suggested the isolation of HCV infected patients to control the spread of HCV infection within HD units
The frequency of HCV infection is decreasing within dialysis units in many highincome countries
Summary
Liver damage is relatively common in patients with chronic kidney disease, those on regular dialysis and kidney transplant recipients. Some surveys have reported a reduction in the prevalence and incidence of HCV infection within dialysis units, but the extent of ongoing transmission of HCV between patients on regular hemodialysis is still unclear. The epidemiology of HCV in the hemodialysis population remains a hot topic, and various approaches have been adopted to prevent the spread of HCV, with controversial results. The aim of this narrative review is to give updated information on epidemiology and risk factors for hepatitis C virus in the dialysis population
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