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Hepatitis B and C and renal failure.

S L Zacks¹, M W Fried

¹Division of Digestive Diseases and Nutrition, University of North Carolina at Chapel Hill, North Carolina, USA.

Infectious Disease Clinics of North America

|September 26, 2001

Summary

Hepatitis C (HCV) is common in dialysis patients, with infection rates up to 30%. While overt liver disease is rare, HCV may impact long-term survival after kidney transplants, requiring further study.

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Area of Science:

Nephrology
Hepatology
Infectious Diseases

Background:

Hepatitis C virus (HCV) is a leading cause of liver disease among dialysis patients.
Prevalence of anti-HCV antibodies ranges from 6% to 38%, with HCV RNA positivity reaching 20-30% in this population.
Blood transfusions, contaminated equipment, and nosocomial transmission are key risk factors for HCV infection in hemodialysis patients.

Purpose of the Study:

To review the prevalence, transmission, natural history, and impact of Hepatitis C infection in patients with chronic renal failure undergoing hemodialysis.
To highlight the challenges in characterizing HCV's long-term effects on morbidity and mortality in end-stage renal disease (ESRD) patients.

Main Methods:

Review of existing literature on Hepatitis C prevalence and outcomes in dialysis and ESRD patients.
Analysis of data from national surveillance and serological testing (EIA, PCR).

Main Results:

HCV prevalence in dialysis patients is significant, with infection risk correlating with hemodialysis duration and transfusion history.
The natural history of HCV in renal failure patients shows milder liver inflammation and less frequent overt liver disease compared to non-dialysis patients.
While short-term mortality post-transplant is not significantly increased, long-term graft and patient survival may be affected by HCV infection.

Conclusions:

HCV infection poses a considerable burden on dialysis patients, with transmission routes needing continued vigilance.
The long-term consequences of HCV in ESRD patients, particularly post-transplant, require further investigation.
Better understanding of HCV mechanisms and improved treatment strategies are crucial for this high-risk population.

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