Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease
Publication Date: November 17, 2022
Last Updated: January 31, 2023
Chapter 1: Detection and evaluation of HCV in CKD
1.1: Screening patients with chronic kidney disease (CKD) for hepatitis C virus (HCV) infection
We recommend screening all patients for HCV infection at the time of initial evaluation of CKD. (1, C)
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We recommend using an immunoassay followed by nucleic acid testing (NAT) if immunoassay is positive. (1, A)
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We recommend screening all patients for HCV infection upon initiation of in-center hemodialysis or upon transfer from another dialysis facility or modality. (1, A)
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We recommend using NAT alone or an immunoassay followed by NAT if immunoassay is positive. (1, A)
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We suggest screening all patients for HCV infection upon initiation of peritoneal dialysis or home hemodialysis. (2, D)
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We recommend screening all patients for HCV infection at the time of evaluation for kidney transplantation. (1, A)
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Chapter 2: Treatment of HCV infection in patients with CKD
We recommend that all patients with CKD (G1-G5), on dialysis (G5D), and kidney transplant recipients (G1T-G5T) with HCV be evaluated for direct-acting antiviral (DAA)-based therapy as outlined in Figure 1. (1, A)
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We recommend that the choice of specific regimen be based on prior treatment history, drug–drug interactions, GFR, stage of hepatic fibrosis, kidney and liver transplant candidacy, and comorbidities. (1, A)
If pangenotypic regimens are not available, HCV genotype (and subtype) should guide the choice of treatment (Figure 1).
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Treat kidney transplant candidates in collaboration with the transplant center to optimize timing of therapy. (N, G)
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We recommend pre-treatment assessment for drug–drug interactions between the DAA-based regimen and other concomitant medications including immunosuppressive drugs in kidney transplant recipients. (1, A)
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We recommend that calcineurin inhibitor levels be monitored during and after DAA treatment in kidney transplant recipients. (1, B)
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Overview
Title
Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease
Authoring Organization
Kidney Disease Improving Global Outcomes