Hepatitis C virus in chronic dialysis patients

Since the cloning of hepatitis C virus (HCV), numerous serologic and virologic tests for detecting HCV infection have been developed and implemented in clinical practice. As a result, significant advances have been made in the study of HCV infection in patients with end-stage kidney disease. Patients on hemodialysis have a higher incidence and prevalence of HCV infection than the general population. In addition, HCV infection affects adversely survival among patients with end-stage kidney disease. Risk factors for HCV infection in dialysis patients include number of blood transfusions, duration of hemodialysis, mode of dialysis, prevalence of HCV infection in the dialysis unit, previous organ transplantation, intravenous drug use, male gender, older age and nosocomial transmission of HCV in hemodialysis units that can occur due to breakdown in standard infection control practices, physical proximity to an infected patient, cross-infection through dialysis machines, disrupted integrity of dialyzer membrane or dialyzer reprocessing. Suggested strategies to control HCV transmission in hemodialysis units include strict adherence to universal precautions, careful attention to hygiene, sterilization of dialysis machines and routine serologic testing and surveillance for HCV infection. Antiviral therapy with interferon alpha is recommended for selected categories of HCV-infected hemodialysis patients and kidney transplant candidates.