Executive summary of the 2018 KDIGO Hepatitis C in CKD Guideline: welcoming advances in evaluation and management

Abstract

g u i d e l i n e s u m m a r y Kidney International (2018) 94, 663-673 Algorithm 1 | Treatment scheme for chronic kidney disease (CKD) G1 to G5D. (See Algorithm 2 for kidney transplant recipients.) Recommendation grades (1À2) and strength of evidence (AÀD) are provided for each recommended treatment regimen and hepatitis C virus (HCV) genotype; see full guideline. 1 DAA, direct-acting antiviral; GFR, glomerular filtration rate; NAT, nucleic acid testing. M Jadoul et al.: Summary of 2018 KDIGO HCV in CKD Guideline g u i d e l i n e s u m m a r y Kidney International (2018) 94, 663-673 g u i d e l i n e s u m m a r y M Jadoul et al.: Summary of 2018 KDIGO HCV in CKD Guideline

Safety and efficacy of direct-acting antivirals for chronic hepatitis C in patients with chronic kidney disease

“…Hepatitis C virus (HCV) affects over 70 million people worldwide, corresponding to 1.0% of the global population [1]. Public interest in HCV is growing, especially since the virus can also induce extrahepatic manifestations (in 40-70% of cases) including autoimmunity-related symptoms, metabolic, renal, cardiovascular, central nervous system or lymphoproliferative disorders [2,3].…”

HCV in the haemodialysis population: Treat now or later?

“…But, HCV treatment in HD patients is not endorsed as a strategy to prevent HCV transmission within HD units. 4 However, for individual patients there may be a number of other considerations mainly related to potential renal transplantation candidacy and use of organs from HCV seropositive donors. HCV transmission can occur from HCV viremic donors to recipients.…”

“…A series of studies have confirmed that HCV transmission on HD reflects lack of adherence to these precautions . In contrast to the prevention of hepatitis B transmission in this setting, dedicated dialysis machines for HCV‐infected patients are not recommended . The likelihood of HCV acquisition while on HD is increased in units with a higher background prevalence of HCV infection, so an infected HD patient also places others at risk.…”

“…In addition to diminishing, the likelihood of hepatic or extra‐hepatic complications, successful treatment of HCV in an HD patient which improves the overall survival of HD patients also eliminates a potential source of infection to others. But, HCV treatment in HD patients is not endorsed as a strategy to prevent HCV transmission within HD units …”

“…In Europe, the World Health Organization HCV elimination plan for 2030 appears to be achievable based on micro‐elimination initiatives, including in the HD setting. To reduce the individual and community consequences of HCV chronic infection in HD units (ie, increased morbidity and the risk of HCV transmission, respectively), DAA treatment should be given to HCV‐infected HD patients . In addition, ongoing antiviral therapy should not limit access to kidney transplantation, and prior HCV cure (just like absence of previous HCV infection) will not contraindicate the use of HCV RNA‐positive allografts.…”