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[Management of hepatitis B virus and hepatitis C virus infection in chronic kidney failure]

Anaïs Vallet-Pichard1, Stanislas Pol1

  • 1Unité d'hépatologie, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U 1016, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université Paris-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.

Nephrologie & Therapeutique
|October 2, 2015
PubMed

Insights

Screening for hepatitis B (HBV) and C (HCV) is crucial for dialysis and kidney transplant patients. Early diagnosis and new antiviral treatments improve outcomes, while vaccination and hygiene prevent infections.

Area of Science:

  • Nephrology
  • Hepatology
  • Infectious Diseases

Background:

  • Chronic hepatitis B (HBV) and C (HCV) infections pose significant diagnostic and therapeutic challenges in dialysis and kidney transplant recipients.
  • Nosocomial exposure, including blood transfusions, contributes to the high prevalence of HBV and HCV in this vulnerable population.
  • These chronic infections negatively impact patient and allograft survival and increase the risk of de novo glomerulonephritis.

Purpose of the Study:

  • To highlight the importance of screening for HBV and HCV markers in all dialysis patients, regardless of transplantation candidacy.
  • To discuss the evaluation of liver disease severity using liver biopsy and the limitations of noninvasive markers in renal patients.
  • To review current and emerging therapeutic strategies for HBV and HCV in kidney disease patients.

Main Methods:

  • Review of diagnostic and therapeutic guidelines for HBV and HCV in dialysis and kidney transplant patients.
  • Discussion of the role of liver biopsy in assessing liver disease severity and guiding antiviral therapy.
  • Analysis of treatment outcomes with direct-acting antivirals for HCV and nucleos(t)tidic analogues for HBV.

Main Results:

  • HCV treatment has shifted to potent and well-tolerated oral direct-acting antivirals, overcoming limitations of previous interferon-based therapies.
  • Second-generation nucleos(t)tidic analogues (entecavir, tenofovir) effectively suppress HBV replication and are recommended for dialysis patients with significant fibrosis and transplant candidates.
  • Liver biopsy remains essential for accurate fibrosis staging in renal patients, as noninvasive markers show reduced accuracy.

Conclusions:

  • Mandatory screening for HBV and HCV markers is essential for all dialysis patients.
  • Timely and appropriate antiviral therapy, alongside preventive measures like vaccination and hygiene, can significantly improve outcomes for HBV and HCV-infected kidney disease patients.
  • Careful patient selection and management are crucial for successful renal transplantation in patients with or at risk of viral hepatitis.

Keywords:
DialysisHepatitis B virusHepatitis C virusHépatites viralesRenal transplantationTransplantation rénaleViral hepatitisVirus de l’hépatite BVirus de l’hépatite CÉpuration extrarénale

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