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The epidemiology of HCV infection in patients with advanced CKD/ESRD: A global perspective

Fabrizio Fabrizi1, Piergiorgio Messa1,2

  • 1Division of Nephrology, Maggiore Hospital and IRCCS Foundation, Milan, Italy.

Seminars in Dialysis
|December 12, 2018
PubMed

Insights

Hepatitis C virus (HCV) significantly increases mortality in chronic kidney disease patients. Strict infection control and screening in hemodialysis units are crucial for preventing HCV transmission, with new antivirals offering hope for patient cure.

Area of Science:

  • Nephrology
  • Hepatology
  • Infectious Diseases

Background:

  • Liver disease, primarily from Hepatitis C Virus (HCV), is a major cause of mortality in Chronic Kidney Disease (CKD) patients.
  • HCV remains highly prevalent in hemodialysis patients globally, despite reduced rates in developed nations due to enhanced preventive measures.
  • HCV outbreaks frequently occur in dialysis facilities, underscoring transmission risks.

Purpose of the Study:

  • To review the prevalence and transmission dynamics of HCV in patients with chronic kidney disease, particularly those undergoing hemodialysis.
  • To emphasize the critical role of infection control and screening in preventing HCV spread within dialysis units.
  • To discuss the impact of novel antiviral therapies on HCV management in hemodialysis populations.

Main Methods:

  • Literature review of studies on HCV prevalence in pre-dialysis and hemodialysis patients.
  • Analysis of data on HCV transmission outbreaks in healthcare settings, with a focus on dialysis units.
  • Discussion of current preventive strategies and emerging treatment modalities for HCV in CKD patients.

Main Results:

  • HCV seropositivity prevalence in maintenance dialysis patients ranges from 1.4%-28.3% in developed countries and 4.7%-41.9% in developing countries.
  • Over 50% of reported healthcare-associated HCV outbreaks between 2008-2015 occurred in dialysis facilities.
  • Strict adherence to infection control and routine screening are vital for preventing HCV transmission, even with low prevalence.

Conclusions:

  • HCV infection poses a significant mortality risk for CKD patients, especially those on hemodialysis.
  • Proactive infection control measures and regular screening are essential to mitigate HCV transmission in hemodialysis units.
  • The availability of directly acting antivirals offers a promising approach to cure HCV in hemodialysis patients, thereby reducing intrahospital transmission and overall infection rates.

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