Hepatitis C virus infection and global kidney health: the consensus proceedings of the International Federation of Kidney Foundations

Abstract

Hepatitis C virus (HCV) infection is an important cause of major morbidities including chronic liver disease, liver cancer, acute kidney injury and chronic kidney disease (CKD). Among patients with kidney disease who have HCV infection, the clinical outcomes are worse. The prevalence of HCV infection is exceptionally high among dialysis and kidney transplant patients throughout the globe. It is estimated that 5% to 25% or more of dialysis-dependent patients are affected. Almost half of all deaths in CKD patients, including HCV-infected patients, are due to cardiovascular disease, and HCV-infected patients have higher mortality. Given the importance and impact of the HCV epidemic on global kidney health, and the status of Egypt as the nation with the highest prevalence of HCV infection in the world along with its initiatives to eradicate HCV, the International Federation of Kidney Foundations convened a consensus conference in Cairo in December 2017. This article reflects the opinions and recommendations of the contributing experts and reiterates that, with the current availability of highly effective and well tolerated pharmacotherapy, CKD patients should be given priority for the treatment of HCV, as an important step towards the World Health Organization’s goal of eliminating viral hepatitis as a public health problem by 2030.

Chronic kidney disease

“…Evidence suggests that uremia is associated with worse immunologic response, as exemplified by diminished antibody response to hepatitis B vaccination or higher risk of infections as kidney function worsens not explained otherwise by concurrent comorbidities, as well as the historical observation that autoimmune diseases such as systemic lupus erythematosus are less aggressive once patients are uremic. 189 Similarly, some infection such as hepatitis C virus may cause CKD if remain untreated, or may lead to CKD, 190,191 or with pre-existing CKD may lead to faster disease progression and greater mortality. 192 Conversely, it is possible that treatment of hepatitis C can have a salutary effect in preserving kidney function.…”

The impact of HCV eradication using interferon-free direct acting antivirals on bone-mineral, anemia parameters and peripheral insulin resistance in hepatitis c-infected Egyptian hemodialysis cohort

“…Chronic kidney disease (CKD) stages 4-5, including dialysis patients and kidney transplant recipients, can be cured of HCV. HCV genotype, viral load, estimated glomerular filtration rate (e-GFR), concomitant medications, comorbidities, and transplantation candidacy should all be taken into account when selecting a DAAs regimen [7]. The approval of an oral IFN-free, direct acting antiviral (DAA) regimen for hemodialysis patients in Egypt in 2014 heralded a paradigm shift in hepatitis C treatment.…”

Prevalent coinfection and associated factors for Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus in patients submitted to renal replacement therapy: A cross-sectional study of 21 dialysis units in the State of Mexico

“…This association has been documented since 1990’s, as patients submitted to RRT had increased exposure to blood transfusions and hemodialysis interventions [ 3 – 5 ]. Since then, diverse global efforts have been performed to create public-health strategies to mitigate the rate of HBV, HCV and HIV coinfection [ 6 ].…”