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Hepatic disorders in chronic kidney disease
Fabrizio Fabrizi1, Piergiorgio Messa, Carlo Basile
1Division of Nephrology and Dialysis, Maggiore Hospital, IRCCS Foundation, Pad. Croff, Via Commenda 15, 20122 Milano, Italy. fabrizi@policlinico.mi.it
Nature Reviews. Nephrology
|April 14, 2010
Summary
Hepatitis B and C virus infections significantly impact survival in chronic kidney disease patients. Careful donor selection and management are crucial for renal transplant recipients to mitigate risks associated with these liver infections.
Area of Science:
- Nephrology
- Hepatology
- Transplantation Immunology
Background:
- Hepatitis B virus (HBV) and hepatitis C virus (HCV) are leading causes of liver damage in chronic kidney disease (CKD) patients.
- The long-term effects of HBV and HCV in CKD populations are not fully understood but impact survival.
- Chronic liver disease is a significant cause of mortality post-renal transplantation.
Purpose of the Study:
- To review the natural history and impact of HBV and HCV infections in patients with CKD.
- To analyze the adverse effects of these viral infections on survival, particularly after renal transplantation.
- To discuss current guidelines and treatment considerations for HBV and HCV in CKD patients.
Main Methods:
- Review of recent evidence and clinical guidelines concerning HBV and HCV in CKD.
- Analysis of survival data for renal transplant recipients with and without HBV/HCV infection.
- Examination of transmission routes and complications associated with HCV in transplant recipients.
Main Results:
- HBV and/or HCV infection adversely affect survival in CKD patients.
- HCV infection is linked to poorer survival post-renal transplantation due to liver dysfunction and extrahepatic issues.
- Kidney recipients from HCV-positive donors face increased mortality risk; guidelines now restrict use in HCV-seropositive recipients.
Conclusions:
- HBV and HCV pose significant risks to CKD patients and renal transplant recipients.
- Management strategies must address viral infections to improve patient outcomes.
- Further research is needed to fully elucidate the natural history and optimize treatment in this vulnerable population.
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