Current Hepatitis Reports

, Volume 10, Issue 3, pp 196–203 | Cite as

Hepatitis C Virus and End Stage Renal Disease



Hepatitis C virus (HCV) is one of the leading causes of chronic liver disease in the world. It is particularly common in patients with end-stage renal disease (ESRD), both due to risk for chronic kidney disease related to HCV infection and risk for HCV infection acquisition in the hemodialysis population. In the United States, nosocomial risk of HCV has diminished, but this continues to be a major challenge in the developing world. Current available HCV therapies are more complex and less efficacious in the setting of ESRD. In the setting of donor organ shortage, transplant specialists must weigh the risks and benefits of using donor kidneys from patients positive for HCV antibody. The goal of this review is to update the reader on significant findings in HCV and ESRD. The major topics covered include updates in epidemiology, natural history, HCV treatment, and transplantation.


Hepatitis C virus Chronic kidney disease End stage renal disease Hemodialysis 


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Lavanchy D. The global burden of hepatitis C. Liver Int. 2009;29 Suppl 1:74–81.PubMedCrossRefGoogle Scholar
  2. 2.
    Thompson ND, Hellinger WC, Kay RS, et al. Healthcare-associated hepatitis C virus transmission among patients in an abdominal organ transplant center. Transpl Infect Dis. 2009;11:324–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Thompson ND, Novak RT, Datta D, et al. Hepatitis C virus transmission in hemodialysis units: importance of infection control practices and aseptic technique. Infect Control Hosp Epidemiol. 2009;30:900–3.PubMedCrossRefGoogle Scholar
  4. 4.
    Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital health care-associated hepatitis B and C virus transmission: United States, 1998–2008. Ann Intern Med. 2009;150:33–9.PubMedGoogle Scholar
  5. 5.
    Centers for Disease Control and Prevention (CDC). Evaluation of acute hepatitis C infection surveillance—United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59:1407–10.Google Scholar
  6. 6.
    •• Centers for Disease Control and Prevention (CDC). Hepatitis C virus transmission at an outpatient hemodialysis unit--New York, 2001–2008. MMWR Morb Mortal Wkly Rep. 2009;58:189–94. Outbreaks of HCV in developed nations is especially concerning. This article also contains the CDC recommendations for HCV surveillence in HD units. Google Scholar
  7. 7.
    Afifi A, Abdel-Mohsen W. Hepatitis C virus infection among hemodialysis patients in developing countries; a major health problem. UNINET. 2009;5.Google Scholar
  8. 8.
    Santoro D, Mazzaglia G, Savica V, Li Vecchi M, Bellinghieri G. Hepatitis status and mortality in hemodialysis population. Ren Fail. 2009;31:6–12.PubMedCrossRefGoogle Scholar
  9. 9.
    Trevizoli JE, de Paula Menezes R, Ribeiro Velasco LF, et al. Hepatitis C is less aggressive in hemodialysis patients than in nonuremic patients. Clin J Am Soc Nephrol. 2008;3:1385–90.PubMedCrossRefGoogle Scholar
  10. 10.
    Khurana A, Nickel AE, Narayanan M, Foulks CJ. Effect of hepatitis C infection on anemia in hemodialysis patients. Hemodial Int. 2008;12:94–9.PubMedCrossRefGoogle Scholar
  11. 11.
    •• Liu CH, Liang CC, Liu CJ, et al. Pegylated interferon alfa-2a monotherapy for hemodialysis patients with acute hepatitis C. Clin Infect Dis. 2010;51:541–9. This study included patients with well defined acute HCV in the setting of HD who were treated with PEG-interferon with excellent response rates. PubMedCrossRefGoogle Scholar
  12. 12.
    Fabrizi F, Dixit V, Messa P, Martin P. Pegylated interferon monotherapy of chronic hepatitis C in dialysis patients: meta-analysis of clinical trials. J Med Virol. 2010;82:768–75.PubMedCrossRefGoogle Scholar
  13. 13.
    •• Kucirka LM, Singer AL, Ros RL, Montgomery RA, Dagher NN, Segev DL. Underutilization of hepatitis C-positive kidneys for hepatitis C-positive recipients. Am J Transplant. 2010;10:1238–46. This study analyzed data from the UNOS database to characterize the national utilization of anti-HCV (+) donor kidneys. They found that anti-HCV (+) kidneys were at risk for being discarded. PubMedCrossRefGoogle Scholar
  14. 14.
    Okoh EJ, Buccier JR, Simon JF, Harrison SA. HCV in patients with end-stage renal disease. Am J Gastroenterol. 2008;103:2123–34.PubMedCrossRefGoogle Scholar
  15. 15.
    Botelho SM, Ferreira RC, Reis NR, et al. Epidemiological aspects of hepatitis C virus infection among renal transplant recipients in Central Brazil. Mem Inst Oswaldo Cruz. 2008;103:472–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Alavian SM, Kabir A, Ahmadi AB, Lankarani KB, Shahbabaie MA, Ahmadzad-Asl M. Hepatitis C infection in hemodialysis patients in Iran: a systematic review. Hemodial Int. 2010;14:253–62.PubMedCrossRefGoogle Scholar
  17. 17.
    El-kader Y, El-Ottol A, Elmanama AA, Ayesh BM. Prevalence and risk factors of hepatitis B and C viruses among haemodialysis patients in Gaza strip, Palestine. Virol J. 2010;7:210.CrossRefGoogle Scholar
  18. 18.
    Johnson DW, Dent H, Yao Q, et al. Frequencies of hepatitis B and C infections among haemodialysis and peritoneal dialysis patients in Asia-Pacific countries: analysis of registry data. Nephrol Dial Transplant. 2009;24:1598–603.PubMedCrossRefGoogle Scholar
  19. 19.
    Agarwal SK, Dash SC, Gupta S, Pandey RM. Hepatitis C virus infection in haemodialysis: the ‘no-isolation’ policy should not be generalized. Nephron Clin Pract. 2009;111:c133–40.PubMedCrossRefGoogle Scholar
  20. 20.
    Agarwal SK. Hemodialysis of patients with HCV infection: isolation has a definite role. Nephron Clin Pract. 2010;117:c328–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Basseri B, Yamini D, Chee G, Enayati PD, Tran T, Poordad F. Comorbidities associated with the increasing burden of hepatitis C infection. Liver Int. 2010;30:1012–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Saune K, Kamar N, Miedouge M, et al. Decreased prevalence and incidence of HCV markers in haemodialysis units: a multicentric French survey. Nephrol Dial Transplant. 2010.Google Scholar
  23. 23.
    Noureddine LA, Usman SA, Yu Z, Moorthi RN, Moe SM. Hepatitis C increases the risk of progression of chronic kidney disease in patients with glomerulonephritis. Am J Nephrol. 2010;32:311–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Della Rossa A, Tavoni A, D’Ascanio A, et al. Mortality rate and outcome factors in mixed cryoglobulinaemia: the impact of hepatitis C virus. Scand J Rheumatol. 2010;39:167–70.PubMedCrossRefGoogle Scholar
  25. 25.
    Fischer MJ, Wyatt CM, Gordon K, et al. Hepatitis C and the risk of kidney disease and mortality in veterans with HIV. J Acquir Immune Defic Syndr. 2010;53:222–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Moe SM, Pampalone AJ, Ofner S, Rosenman M, Teal E, Hui SL. Association of hepatitis C virus infection with prevalence and development of kidney disease. Am J Kidney Dis. 2008;51:885–92.PubMedCrossRefGoogle Scholar
  27. 27.
    Butt AA, Wang X, Fried LF. HCV infection and the incidence of CKD. Am J Kidney Dis. 2011;57:396–402.PubMedCrossRefGoogle Scholar
  28. 28.
    Lemos LB, Perez RM, Matos CA, Silva IS, Silva AE, Ferraz ML. Clinical and laboratory characteristics of acute hepatitis C in patients with end-stage renal disease on hemodialysis. J Clin Gastroenterol. 2008;42:208–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Patel PR, Thompson ND, Kallen AJ, Arduino MJ. Epidemiology, surveillance, and prevention of hepatitis C virus infections in hemodialysis patients. Am J Kidney Dis. 2010;56:371–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Yasuda K, Okuda K, Endo N, et al. Hypoaminotransferasemia in patients undergoing long-term hemodialysis: clinical and biochemical appraisal. Gastroenterology. 1995;109:1295–300.PubMedCrossRefGoogle Scholar
  31. 31.
    Lopes EP, Sette LH, Sette JB, et al. Serum alanine aminotransferase levels, hematocrit rate and body weight correlations before and after hemodialysis session. Clinics (Sao Paulo). 2009;64:941–5.Google Scholar
  32. 32.
    Souza JF, Longui CA, Miorin LA, Sens YA. Gamma-glutamyltransferase activity in chronic dialysis patients and renal transplant recipients with hepatitis C virus infection. Transplant Proc. 2008;40:1319–23.PubMedCrossRefGoogle Scholar
  33. 33.
    Miedouge M, Saune K, Kamar N, Rieu M, Rostaing L, Izopet J. Analytical evaluation of HCV core antigen and interest for HCV screening in haemodialysis patients. J Clin Virol. 2010;48:18–21.PubMedCrossRefGoogle Scholar
  34. 34.
    Galperim B, Mattos AA, Stein AT, et al. Hepatitis C in hemodialysis: the contribution of injection drug use. Braz J Infect Dis. 2010;14:422–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Fabrizi F, Takkouche B, Lunghi G, Dixit V, Messa P, Martin P. The impact of hepatitis C virus infection on survival in dialysis patients: meta-analysis of observational studies. J Viral Hepat. 2007;14:697–703.PubMedGoogle Scholar
  36. 36.
    Henderson WA, Shankar R, Gill JM, et al. Hepatitis C progressing to hepatocellular carcinoma: the HCV dialysis patient in dilemma. J Viral Hepat. 2010;17:59–64.PubMedCrossRefGoogle Scholar
  37. 37.
    Fassio E. Hepatitis C and hepatocellular carcinoma. Ann Hepatol. 2010;9(Suppl):119–22.PubMedGoogle Scholar
  38. 38.
    Fabrizi F, Messa P, Basile C, Martin P. Hepatic disorders in chronic kidney disease. Nat Rev Nephrol. 2010;6:395–403.PubMedCrossRefGoogle Scholar
  39. 39.
    Sterling RK, Sanyal AJ, Luketic VA, et al. Chronic hepatitis C infection in patients with end stage renal disease: characterization of liver histology and viral load in patients awaiting renal transplantation. Am J Gastroenterol. 1999;94:3576–82.PubMedCrossRefGoogle Scholar
  40. 40.
    Sahin I, Arabaci F, Sahin HA, et al. Does hepatitis C virus infection increase hematocrit and hemoglobin levels in hemodialyzed patients? Clin Nephrol. 2003;60:401–4.PubMedGoogle Scholar
  41. 41.
    Landreneau K, Lee K, Landreneau MD. Quality of life in patients undergoing hemodialysis and renal transplantation—a meta-analytic review. Nephrol Nurs J. 2010;37:37–44.PubMedGoogle Scholar
  42. 42.
    Foster GR. Quality of life considerations for patients with chronic hepatitis C. J Viral Hepat. 2009;16:605–11.PubMedCrossRefGoogle Scholar
  43. 43.
    Afsar B, Elsurer R, Sezer S, Ozdemir NF. Quality of life in hemodialysis patients: hepatitis C virus infection makes sense. Int Urol Nephrol. 2009;41:1011–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Fabrizi F, Messa P, Martin P. Health-related quality of life in dialysis patients with HCV infection. Int J Artif Organs. 2009;32:473–81.PubMedGoogle Scholar
  45. 45.
    Fabrizi F, Dixit V, Messa P, Martin P. Interferon monotherapy of chronic hepatitis C in dialysis patients: meta-analysis of clinical trials. J Viral Hepat. 2008;15:79–88.PubMedGoogle Scholar
  46. 46.
    Gordon CE, Uhlig K, Lau J, Schmid CH, Levey AS, Wong JB. Interferon treatment in hemodialysis patients with chronic hepatitis C virus infection: a systematic review of the literature and meta-analysis of treatment efficacy and harms. Am J Kidney Dis. 2008;51:263–77.PubMedCrossRefGoogle Scholar
  47. 47.
    Casanovas Taltavull T, Baliellas Comellas C, Cruzado Garrit JM. Results of hepatitis C virus treatment in patients on hemodialysis: data from published meta-analyses in 2008. Transplant Proc. 2009;41:2082–4.PubMedCrossRefGoogle Scholar
  48. 48.
    Werner T, Aqel B, Balan V, et al. Treatment of hepatitis C in renal transplantation candidates: a single-center experience. Transplantation. 2010;90:407–11.PubMedCrossRefGoogle Scholar
  49. 49.
    Akhan SC, Kalender B, Ruzgar M. The response to pegylated interferon alpha 2a in haemodialysis patients with hepatitis C virus infection. Infection. 2008;36:341–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Alsaran K, Sabry A, Shaheen N. Pegylated interferon alpha-2a for treatment of chronic HCV infection in hemodialysis patients: a single Saudi center experience. Int Urol Nephrol. 2010.Google Scholar
  51. 51.
    Ayaz C, Celen MK, Yuce UN, Geyik MF. Efficacy and safety of pegylated-interferon alpha-2a in hemodialysis patients with chronic hepatitis C. World J Gastroenterol. 2008;14:255–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Basic-Jukic N, Gulin M, Slavicek J, et al. Pegylated interferon for treatment of chronic hepatitis C in hemodialysis patients in Croatia. Kidney Blood Press Res. 2011;34:53–7.PubMedCrossRefGoogle Scholar
  53. 53.
    Carriero D, Fabrizi F, Uriel AJ, Park J, Martin P, Dieterich DT. Treatment of dialysis patients with chronic hepatitis C using pegylated interferon and low-dose ribavirin. Int J Artif Organs. 2008;31:295–302.PubMedGoogle Scholar
  54. 54.
    Dzekova P, Asani A, Selim G, et al. Long-term follow-up of sustained viral response after treatment of hepatitis C with pegylated interferon alpha-2a in hemodialysis patients. Int J Artif Organs. 2009;32:180–4.PubMedGoogle Scholar
  55. 55.
    Pageaux GP, Hilleret MN, Garrigues V, et al. Pegylated interferon-alpha-based treatment for chronic hepatitis C in renal transplant recipients: an open pilot study. Transpl Int. 2009;22:562–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Tan SS, Abu Hassan MR, Abdullah A, Ooi BP, Korompis T, Merican MI. Safety and efficacy of an escalating dose regimen of pegylated interferon alpha-2b in the treatment of haemodialysis patients with chronic hepatitis C. J Viral Hepat. 2010;17:410–8.PubMedCrossRefGoogle Scholar
  57. 57.
    Ucmak H, Kokoglu OF, Hosoglu S, et al. Long-term efficacy of pegylated interferon alpha-2a in HCV-positive hemodialysis patients. Ren Fail. 2008;30:227–32.PubMedCrossRefGoogle Scholar
  58. 58.
    Peck-Radosavljevic M, Boletis J, Besisik F, et al. Low-dose peginterferon alfa-2a is safe and produces a sustained virologic response in patients with chronic hepatitis C and end-stage renal disease. Clin Gastroenterol Hepatol. 2011;9:242–8.PubMedCrossRefGoogle Scholar
  59. 59.
    Bruchfeld A, Lindahl K, Reichard O, Carlsson T, Schvarcz R. Pegylated interferon and ribavirin treatment for hepatitis C in haemodialysis patients. J Viral Hepat. 2006;13:316–21.PubMedCrossRefGoogle Scholar
  60. 60.
    Hakim W, Sheikh S, Inayat I, et al. HCV response in patients with end stage renal disease treated with combination pegylated interferon alpha 2-a and ribavirin. J Clin Gastroenterol. 2009;43(5):477–481.Google Scholar
  61. 61.
    •• Fabrizi F, Dixit V, Martin P, Messa P. Combined antiviral therapy of hepatitis C virus in dialysis patients: meta-analysis of clinical trials. J Viral Hepat. 2010. This meta-analysis examined studies of HCV/ESRD patients treated with interferon and ribavirin. An impressive SVR was found with only a slightly higher drop-out rate than would be expected for interferon alone was found. Google Scholar
  62. 62.
    Olson MR, Grewal KS, Bingaman A, et al. An international survey of the diagnosis, management, and treatment of hepatitis C in patients with end-stage renal disease. Exp Clin Transplant. 2009;7:203–13.PubMedGoogle Scholar
  63. 63.
    Rocha CM, Perez RM, Narciso JL, et al. Interferon-alpha therapy within the first year after acute hepatitis C infection in hemodialysis patients: efficacy and tolerance. Eur J Gastroenterol Hepatol. 2007;19:119–23.PubMedCrossRefGoogle Scholar
  64. 64.
    Kempf DJ, Klein C, Chen HJ, et al. Pharmacokinetic enhancement of the hepatitis C virus protease inhibitors VX-950 and SCH 503034 by co-dosing with ritonavir. Antivir Chem Chemother. 2007;18:163–7.PubMedGoogle Scholar
  65. 65.
    Seden K, Back D, Khoo S. New directly acting antivirals for hepatitis C: potential for interaction with antiretrovirals. J Antimicrob Chemother. 2010;65:1079–85.PubMedCrossRefGoogle Scholar
  66. 66.
    Ghosal A, Yuan Y, Tong W, et al. Characterization of human liver enzymes involved in the biotransformation of boceprevir, a hepatitis C virus protease inhibitor. Drug Metab Dispos. 2011;39:510–21.PubMedCrossRefGoogle Scholar
  67. 67.
    Maluf DG, Archer KJ, Mas VR. Kidney grafts from HCV-positive donors: advantages and disadvantages. Transplant Proc. 2010;42:2436–46.PubMedCrossRefGoogle Scholar
  68. 68.
    Morales JM, Campistol JM, Dominguez-Gil B, et al. Long-term experience with kidney transplantation from hepatitis C-positive donors into hepatitis C-positive recipients. Am J Transplant. 2010;10:2453–62.PubMedCrossRefGoogle Scholar
  69. 69.
    Mas VR, Archer KJ, Suh L, Scian M, Posner MP, Maluf DG. Distinctive gene expression profiles characterize donor biopsies from HCV-positive kidney donors. Transplantation. 2010;90:1172–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Yelken B, Gorgulu N, Caliskan Y, et al. Association between chronic hepatitis C infection and coronary flow reserve in dialysis patients with failed renal allografts. Transplant Proc. 2009;41:1519–23.PubMedCrossRefGoogle Scholar
  71. 71.
    Barril G, Castillo I, Arenas MD, et al. Occult hepatitis C virus infection among hemodialysis patients. J Am Soc Nephrol. 2008;19:2288–92.PubMedCrossRefGoogle Scholar
  72. 72.
    Castillo I, Bartolome J, Quiroga JA, Barril G, Carreno V. Diagnosis of occult hepatitis C without the need for a liver biopsy. J Med Virol. 2010;82:1554–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Nicot F, Kamar N, Mariame B, Rostaing L, Pasquier C, Izopet J. No evidence of occult hepatitis C virus (HCV) infection in serum of HCV antibody-positive HCV RNA-negative kidney-transplant patients. Transpl Int. 2010;23:594–601.PubMedCrossRefGoogle Scholar
  74. 74.
    Justa S, Minz RW, Minz M, et al. Serial measurements of hepatitis C viral load by real-time polymerase chain reaction among recipients of living-donor renal transplants: a short-term follow-up study from a single center. Transplant Proc. 2010;42:3568–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of California, San DiegoSan DiegoUSA
  2. 2.Division of GastroenterologyUniversity of California, San DiegoSan DiegoUSA

Personalised recommendations