Infection with hepatitis C virus in hemodialysis patients: An overview of the diagnosis and prevention rules within a hemodialysis center (Review)

Abstract

Increase in the number of patients with chronic kidney disease (CKD) calls for improved management of these patients. In stage 5 CKD, when the initiation of renal replacement therapy (RRT) becomes necessary, there is an increase in the infection risk of the patients and immunological tests for hepatitis C virus (HCV) detection turn positive at an alarmingly higher rate compared to general population. With the introduction into clinical practice of diagnostic tests, the increased prevalence of HCV among CKD patients has been known since the 1990s. Also, the negative impacts of HCV infection on CKD evolution as well as the unfavorable evolution of grafts received by HCV infected patients are known. Chronic hemodialysis patients are a category of patients whose risk of HCV infection is substantial. Currently, in the hemodialysis centers, at the base of the transmission of HCV infection there are a multitude of factors. Infection with HCV has a different impact on patient with end-stage renal disease (ESRD). Comorbidities in this case have significant sources of mortality and morbidity. It was proven that the post transplantations problems were prevented and mortality was reduced for patients who were diagnosed with HCV and in whom the infection was treated before the kidney transplant (KT). Consequently, early detection of the infection and the application of specific treatment has a considerable impact on the outcome of the patients. Another important component of the management of HCV infection in the chronic hemodialysis patients is the prevention of the infection transmission by applying specific methods. Contents

Hepatitis C virus and carpal tunnel syndrome in hemodialysis patients: a single center cross-sectional study

“…We speculate that this result might reflect the fact that the appearance of anti-HCV is not evidence of present infection; it is regularly used in preliminary screening of HCV infection as an indicator of previous HCV infection. After the moment of the HCV infection, the serological tests allow for anti-HCV antibodies detection on 7-8 weeks [33]. Anti-HCV antibodies may persist indefinitely in chronic infection patients.…”

An Updated View on the Antiviral Therapy of Hepatitis C in Chronic Kidney Disease

“…After its identification in 1989, it has been observed that patients on renal replacement therapy have commonly detectable anti-HCV antibody in serum. The frequency of patients with positive serology for anti-HCV antibody who undergo maintenance dialysis is still higher than that observed in the respective general population of developed [2] or emerging countries [2,[5][6][7][8][9][10][11][12][13][14][15]. Infection with chronic HCV infection leads to chronic liver disease with its attendant complications (cirrhosis, hepatocellular carcinoma, and hepatocellular failure).…”

Dynamics of serum α‑fetoprotein in viral hepatitis C without hepatocellular carcinoma

“…HCV induces a low-amplitude T and B lymphocyte-mediated immune response, which leads to long-lasting infection and production of non-specific biochemical markers (3)(4)(5). Thus, disease progression is difficult to predict.…”

“…Among the extrahepatic manifestations of HCV infection, an important role is played by renal involvement, being described as a series of histopathological forms: Proliferative membrane glomerulonephritis, IgA nephropathy, focal segmental glomerulosclerosis, fibrillar glomerulonephritis, tubulointerstitial nephropathy and thrombosis ( 2 , 3 ). The prevalence of HCV infection in patients with chronic kidney disease (CKD) is between 5 and 60% in developed countries, with a certain predominance in hemodialysis patients ( 3 ). HCV-positive hemodialysis patients show a decreased survival rate; the risk of death associated with liver disease being aggravated by the increased risk of cardiovascular death attributed to malnutrition and chronic inflammation ( 4 ).…”