Improving outcomes for patients with chronic kidney disease (CKD) and hepatitis C (HCV) has been an ongoing goal for decades. Efforts to improve the prevention, diagnosis, evaluation, and treatment of such patients remains a critical priority and yet guidance is in need of review and revision.
According to the American Liver Foundation, there are an estimated 2.7-3.9 million people living with chronic HCV in the United States, with 17,000 new HCV cases each year.1 As such, and with continuous work to improve treatments through antivirals and early testing, improving these strategies is a continuous need.
A new publication regarding the prevention, diagnosis, evaluation, and treatment of HCV in CKD patients has been published in the Annals of Internal Medicine.2 Made publicly available, this update to improving outcomes globally with 2022 recommendations draws on clinical knowledge and changes since 2018.
What You Need to Know
Chronic kidney disease (CKD) and hepatitis C (HCV) pose significant challenges to healthcare, with an estimated 2.7-3.9 million people living with chronic HCV in the United States.
The guidelines, based on the grade approach, provide 43 graded recommendations and 20 ungraded recommendations, including significant changes and additions compared to the 2018 guidelines.
The 2022 guidelines recommend expanding the treatment of hepatitis C with sofosbuvir-based regimens to patients with CKD glomerular filtration rate categories G4 and G5, including those receiving dialysis.
The Kidney Disease: Improving Global Outcomes (KDIGO) work group navigated these changes using the grade approach, which is grading of recommendations assessment, development, and evaluation to review evidence and recommendations. Within the 2022 guidance, there are 43 graded recommendations and 20 ungraded recommendations, including 7 new or modified after discussions within the work group.
Per the KDIGO work group, these new guidelines “recommend expanding treatment of hepatitis C with sofosbuvir-based regimens to patients with CKD glomerular filtration rate categories G4 and G5, including those receiving dialysis; expanding the donor pool for kidney transplant recipients by accepting HCV-positive kidneys regardless of the recipient’s HCV status; and initiating direct-acting antiviral treatment of HCV-infected patients with clinical evidence of glomerulonephritis without requiring kidney biopsy. The update also addresses the use of immunosuppressive regimens in such patients.”
A beneficial piece of the 2022 guidelines includes a chart drawing attention to the changes between those of 2018. For example, in 2018, sofosbuvir was not recommended in patients with CKD G4 and G5, including those undergoing dialysis, whereas the 2022 guidelines state that Sofosbuvir-based direct-acting antivirals (DAA) regimens can in fact be used in those patients with GFR <30 mL/min/1.73 m2, which includes those receiving dialysis.
The guidelines are broken into helpful chapters addressing management of HCV-infected patients before and after kidney transplantation, diagnosis and management, and treatment of HCV infection in those with CKD. Citing the evolution of treating HCV infection in patients with kidney disease, the authors emphasize the beneficial impact and availability of pangenotypic
DAAs that can now be administered, safely, throughout all stages of CKD. Such improvements and advancements in the care and diagnosis of CKD patients with HCV infections are reflected throughout the new 2022 guidelines and will hopefully improve patient outcomes and efforts to lessen the disease burden.
References
1. American Liver Foundation. Hepatitis C Information Center. August 18, 2023. https://liverfoundation.org/liver-diseases/viral-hepatitis/hepatitis-c/#:~:text=An%20estimated%202.7%20%E2%80%93%203.9%20million,unaware%20that%20they%20are%20infected.
2. Awan AAY, Berenguer MC, Bruchfeld A, Fabrizi F, Goldberg DS, Jia J, Kamar N, Mohamed R, Pessôa MG, Pol S, Sise ME, Balk EM, Gordon CE, Adam G, Cheung M, Earley A, Martin P, Jadoul M. Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2022 Clinical Practice Guideline. Ann Intern Med. 2023 Dec;176(12):1648-1655. doi: 10.7326/M23-2391. Epub 2023 Dec 12. PMID: 38079642.
