Evaluation and Treatment of Hepatitis C in Patients with Chronic Kidney Disease Not on Dialysis

 

This reference tool highlights select guidelines adapted from the KDIGO Clinical Practice Guidelines for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease for implementation in the United States and in accordance with the KDOQI U.S. Commentary.

Adapted from the KDIGO Clinical Practice Guidelines for the Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease.

And the KDOQI U.S. commentary on the KDIGO Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation and Treatment of Hepatitis C in CKD.

Highlights select guidelines.
To view the full Guideline document, visit www.kdigo.org

THE NATURAL HISTORY OF HEPATITIS C IN THE GENERAL POPULATION

HCC=Hepatocellular carcinoma
HIV=Human immunodeficiency virus

Note: Little is known about the natural history of HCV infection in the CKD population, or if it differs substantially from the general population with normal kidney function.

GROUPS AT RISK FOR HEPATITIS C


** Other= Hemodialysis patients; health care workers; perinatal transmission

EVALUATION

GUIDELINE 1.1.1
It is suggested that CKD patients be tested for HCV (weak evidence). Finding HCV gives the chance to offer antiviral treatment to those who could benefit from it.

G 2.1.1
It is suggested that CKD patients with HCV infection be evaluated for antiviral treatment. (Weak)

G 2.1.2
It is suggested that the decision to treat be based on the potential benefits and risks of therapy (Weak):

  • life expectancy
  • candidacy for kidney transplantation
  • comorbidities such as significant coronary artery disease

Applicability of Guideline 1 to the United States

HCV testing of patients with CKD should be performed in patients with unexplained proteinuria, microscopic hematuria, increased aminiotransferase levels and risk factors for HCV acquisition..

Potential benefits:

  • Sustained virologic response (SVR) and slowed progression of liver disease and HCV-mortality. (In the general population, achieving SVR may improve survival and lower the rate of hepatocellular carcinoma. No data exist to indicate that achieving SVR translates into improved survival in the CKD population infected with HCV.)
  • Theoretically lowered all-cause mortality rate. (In the general population, the 5-year mortality rate of HCV-infected patients with compensated cirrhosis is 9%.) In the absence of HCV, the CKD patient has a high mortality rate.