[Hepatitis C infections in dialyzed patients]

Area of Science:

• Nephrology
• Hepatology
• Infectious Diseases

Background:

• Hepatitis C virus (HCV) infection is more prevalent in patients with end-stage renal disease (ESRD) undergoing dialysis compared to the general population.
• The natural history and clinical course of HCV infection in dialyzed patients remain unclear, with varying opinions on its severity.
• Immunosuppressive therapy post-renal transplantation (RTx) negatively impacts HCV-infected patients, and current anti-HCV treatments pose a high risk of graft rejection.

Purpose of the Study:

• To review the current understanding of hepatitis C virus infection in dialyzed patients.
• To evaluate the challenges and recommendations for antiviral therapy in ESRD patients, particularly concerning renal transplantation.
• To highlight the need for wider indications for HCV treatment before RTx.

Main Methods:

• Literature review focusing on studies related to HCV infection in ESRD patients on dialysis.
• Analysis of available data on anti-HCV treatments, including interferon-based therapies and ribavirin.
• Examination of treatment efficacy and safety in the context of renal transplantation.

Main Results:

• Standard interferon monotherapy is the most studied treatment for HCV in dialyzed patients.
• One pegylated interferon has been approved for dialyzed patients, but efficacy and safety data are limited.
• Ribavirin use is contraindicated in ESRD patients due to the significant risk of anemia.

Conclusions:

• Antiviral therapy for HCV infection should be administered prior to renal transplantation.
• Treatment indications for HCV should be broadened to encompass HCV infection, not solely hepatitis.
• Further research is needed on the efficacy and safety of newer antiviral agents, including pegylated interferons, in dialyzed ESRD patients.