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Hepatitis C and Chronic Kidney Disease

Published:February 18, 2022DOI:https://doi.org/10.1053/j.jrn.2022.02.003
      Chronic hepatitis C virus (HCV) affects roughly 58 million people worldwide.
      World Health Organization website
      Hepatitis C.
      In the United States, between 2013 and 2016, an estimated 2.4 million people were living with HCV.
      Centers for Disease Control and Prevention website
      Hepatitis C questions and answers for health professionals.
      Common risk factors include use of illegal intravenous drugs, blood transfusions, having sex with an infected person, getting a tattoo or body piercing with an infected needle, and sharing items like toothbrushes with an infected person.
      National kidney Foundation website
      Understanding hepatitis C.
      Retrospective studies demonstrate that there is an association between HCV and the development of chronic kidney disease (CKD) and end-stage kidney disease (ESKD).
      Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
      KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
      HCV affects the kidneys by chronic inflammation, impaired glucose utilization, and vascular disease.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      In HCV, systemic vasculitis is present which affects small-sized vessels that expand B cells production of pathogenic IgM and IgG and rheumatoid factor activity.
      Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
      KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
      Immune complex deposits result in clinical manifestations that increase both morbidity and mortality and reduce the efficacy of antiviral treatment.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      The risk of ESKD in patients infected with HCV is 7 times higher than noninfected persons and dependent on the viral load.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      The risk of ESKD mortality is also higher in persons with HCV than non-HCV infection.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      Hepatitis C infection is associated with a higher risk of diabetes and vascular disease.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      Antiviral treatment for HCV has been found to improve renal and vascular outcomes.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      Due to higher risk of death and illness, persons with CKD Stages 4 and 5 should be given priority access to HCV treatment.
      Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
      KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
      ,
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      Indications for antiviral treatment are based on the severity of liver fibrosis.
      • Pol S.
      • Parlati L.
      • Jadoul M.
      Hepatitis C virus and the kidney.
      Treatment and standard of care for HCV has progressed over the past 20 years and the World Health Organization estimates 95% cure rates.
      World Health Organization website
      Hepatitis C.
      ,
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      ,
      • Pol S.
      • Parlati L.
      • Jadoul M.
      Hepatitis C virus and the kidney.
      World Health Organization guidelines preferred treatment regimen is either sofosbuvir or daclatasvir or a combination of sofosbuvir/ledipasvir.
      World Health Organization website
      Hepatitis C.
      These direct-acting antiviral drugs have been noted to be more effective than traditional therapies of pegylated interferon alfa and ribavirin and can cure most persons with HCV in 12 weeks.
      World Health Organization website
      Hepatitis C.
      ,
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      ,
      • Pol S.
      • Parlati L.
      • Jadoul M.
      Hepatitis C virus and the kidney.
      Direct-acting antiviral drugs target vital proteins such as NS3/4A protease inhibitors, NS5B nucleostidic and non-nucleostidic polymerase inhibitors, and NS5A replication complex inhibitors.
      • Corouge M.
      • Vallet-Pichard A.
      • Pol S.
      HCV and the kidney.
      Because HCV infection is generally asymptomatic, at risk populations (like persons with CKD) should be screened for anti-HCV antibodies by enzyme immunoassay and followed by nucleic acid testing if the immunoassay is positive.
      Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
      KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
      ,
      • Pol S.
      • Parlati L.
      • Jadoul M.
      Hepatitis C virus and the kidney.
      In persons treated with renal replacement therapy, it is recommended that HCV screening be done upon admission to a dialysis facility and when transferring between dialysis facilities or treatment modalities.
      Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
      KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
      ,
      • Pol S.
      • Parlati L.
      • Jadoul M.
      Hepatitis C virus and the kidney.
      ,
      United States Renal Data System
      Patients who test negative for HCV should be rescreened by enzyme immunoassay every 6 months.
      Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
      KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
      ,
      • Pol S.
      • Parlati L.
      • Jadoul M.
      Hepatitis C virus and the kidney.
      ,
      United States Renal Data System
      Academy of Nutrition and Dietetics Nutrition Care Manual
      Hepatitis nutrition therapy.

      Supplementary Data

      References

        • World Health Organization website
        Hepatitis C.
        • Centers for Disease Control and Prevention website
        Hepatitis C questions and answers for health professionals.
        • National kidney Foundation website
        Understanding hepatitis C.
        • Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group
        KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease.
        Kidney Int Suppl. 2018; 8: 91-165
        • Corouge M.
        • Vallet-Pichard A.
        • Pol S.
        HCV and the kidney.
        Liver Int. 2016; 36: 28-33
        • Pol S.
        • Parlati L.
        • Jadoul M.
        Hepatitis C virus and the kidney.
        Nat Rev Nephrol. 2019; 15: 73-86
        • United States Renal Data System
        https://www.usrds.org/
        Date accessed: February 3, 2022
        • Academy of Nutrition and Dietetics Nutrition Care Manual
        Hepatitis nutrition therapy.
        https://www.nutritioncaremanual.org/about-ncm
        Date accessed: February 6, 2022