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Prevalence, incidence, and risk factors for hepatitis C virus infection in hemodialysis patients

2019; Elsevier BV; Volume: 95; Issue: 4 Linguagem: Inglês

10.1016/j.kint.2018.11.038

1523-1755

Michel Jadoul, Brian Bieber, Paul Martin, Takashi Akiba, Chizoba Nwankwo, Jean Marie Arduino, David A. Goodkin, Ronald L. Pisoni,

Liver Disease and Transplantation

Hepatitis C virus (HCV) infection is common in dialysis patients and is associated with increased morbidity and mortality. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS, 1996–2015) to assess trends in the prevalence, incidence, and risk factors for HCV infection as defined by a documented diagnosis or antibody positivity. Among prevalent hemodialysis patients, HCV prevalence was nearly 10% in 2012–2015. Prevalence ranged from 4% in Belgium to as high as 20% in the Middle East, with intermediate prevalence in China, Japan, Italy, Spain, and Russia. HCV prevalence decreased over time in most countries participating in more than one phase of DOPPS, and prevalence was around 5% among patients who had recently (<4 months) initiated dialysis. The incidence of HCV infection decreased from 2.9 to 1.2 per 100 patient-years in countries participating in the initial phase of DOPPS. Although most units reported no seroconversions, 10% of units experienced 3 or more cases over a median of 1.1 years. High HCV prevalence in the hemodialysis unit was a powerful facility-level risk factor for seroconversion, but the use of isolation stations for HCV-positive patients was not associated with significantly lower seroconversion rates. Overall, despite a trend toward lower HCV prevalence among hemodialysis patients, the prevalence of HCV infection remains higher than in the general population. Combined with a high prevalence of HCV infection among patients with Stage 5 CKD, high rates of HCV seroconversion in a subset of hemodialysis units may contribute to this disparity. Hepatitis C virus (HCV) infection is common in dialysis patients and is associated with increased morbidity and mortality. We used the Dialysis Outcomes and Practice Patterns Study (DOPPS, 1996–2015) to assess trends in the prevalence, incidence, and risk factors for HCV infection as defined by a documented diagnosis or antibody positivity. Among prevalent hemodialysis patients, HCV prevalence was nearly 10% in 2012–2015. Prevalence ranged from 4% in Belgium to as high as 20% in the Middle East, with intermediate prevalence in China, Japan, Italy, Spain, and Russia. HCV prevalence decreased over time in most countries participating in more than one phase of DOPPS, and prevalence was around 5% among patients who had recently (<4 months) initiated dialysis. The incidence of HCV infection decreased from 2.9 to 1.2 per 100 patient-years in countries participating in the initial phase of DOPPS. Although most units reported no seroconversions, 10% of units experienced 3 or more cases over a median of 1.1 years. High HCV prevalence in the hemodialysis unit was a powerful facility-level risk factor for seroconversion, but the use of isolation stations for HCV-positive patients was not associated with significantly lower seroconversion rates. Overall, despite a trend toward lower HCV prevalence among hemodialysis patients, the prevalence of HCV infection remains higher than in the general population. Combined with a high prevalence of HCV infection among patients with Stage 5 CKD, high rates of HCV seroconversion in a subset of hemodialysis units may contribute to this disparity. The authors replyKidney InternationalVol. 97Issue 2PreviewAlthough our Dialysis Outcomes and Practice Patterns Study reported a relatively slow international decrease of hepatitis C virus (HCV) prevalence and incidence in hemodialysis (HD) units from 1996 to 20121 (before the direct-acting antiviral era), Huang et al. now report their direct-acting antiviral–based elimination of HCV from a single HD unit in Taiwan.2 Such eradication of HCV will reduce the clinical burden associated with HCV infection. In addition, HCV eradication should prevent HCV nosocomial transmission. Full-Text PDF Patient-centered outreach treatment toward micro-elimination of hepatitis C virus infection in hemodialysis patientsKidney InternationalVol. 97Issue 2PreviewWe read the report by Jadoul et al.1 with great interest in a recent issue in Kidney International. The World Health Organization has set ambitious goals for hepatitis C virus (HCV) eradication using the "micro-elimination" approach.2 Taiwan has one of the highest prevalence and incidence of end-stage kidney disease worldwide. HCV infection is an important complication among our hemodialysis patients.3 With the advent of the new direct-acting antivirals, complete eradication of HCV infection is one of our key priorities. Full-Text PDF