Hcv Infection In Haemodialysis Patients With End-Stage Renal Disease

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HCV INFECTION IN HAEMODIALYSIS PATIENTS WITH END-STAGE RENAL DISEASE

Abstract

Hepatitis C virus (HCV)-related liver disease is a significant cause of morbidity and mortality in patients with end-stage renal disease (ESRD) who is treated with dialysis or kidney transplantation (KT). The survival rate for HCV-infected renal transplant recipients is better than that for HCV-infected hemodialysis patients on transplant waiting lists. Early diagnosis and treatment HCV infection prior to KT prevents complications post-transplantation and reduces mortality. In addition to screening for anti-HCV antibodies and detecting HCV RNA, percutaneous liver biopsy is particularly valuable for assessing the stage of liver damage in HCV-infected patients, because the stage of fibrosis is important determining optimal treatment for HCV. Studies have been demonstrated that with conventional interferon (IFN) monotherapy or pegylated IFN monotherapy are similar efficacy and safety in HCV-infected hemodialysis patients. Sustained viral responses (SVRs) with these monotherapies have ranged approximately 30% to 40%. Limited reports support the use of IFN and ribavirin combination therapy as antiviral treatment for ESRD patients or patients on hemodialysis. Ribavirin can be started at low dose and careful monitoring for side effects. Patients that show SVR after treatment are strong candidates for KT. It is also generally accepted that ESRD patients with decompensated cirrhosis and portal hypertension should be referred to the liver transplant team for consideration of combined liver-KT.

INTRODUCTION

Liver disease related to hepatitis C virus (HCV) infection is a significant cause of morbidity and mortality in hemodialysis (HD) patients and kidney transplant recipients. In developed countries, the prevalence of anti-HCV seropositivity among patients on maintenance HD ranges between 5% and 60%. Patients on HD are at high risk for HCV, with frequency of infection several times higher than that in non-uremic patients[]. The spread of HCV in HD units is declining, but the prevalence of HCV in HD patients remains high[].

Several observational studies have demonstrated a significant and independent relationship between anti-HCV seropositive status and lower survival rate in patients with end-stage renal disease (ESRD). The two major complications of HCV-related chronic liver disease are cirrhosis and hepatocellular carcinoma, and these are suspected causes of higher mortality among HCV-positive patients.

Management of HCV-positive ESRD patients is complicated. There are unknowns related to prevention of HCV spread in dialysis units, anti-viral therapy in dialysis patients, and effects of HCV infection after renal transplantation. A wide range of studies have been published on HCV in ESRD patients, but clinical evidence is lacking with respect to most of the important issues, and most existing evidence is from uncontrolled clinical trials or retrospective surveys[].

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