Prevalence and Clinical Profile of Hepatitis C Virus Infection in Hemodialysis Units
Hepatitis C virus (HCV) infection remains significantly more prevalent in hemodialysis patients compared to the general population, with prevalence rates several times higher due to nosocomial transmission through blood contamination on staff hands, medications, supplies, and equipment. 1, 2
Epidemiology and Prevalence
The prevalence of HCV in hemodialysis units varies globally but consistently exceeds general population rates
Key risk factors for HCV infection in hemodialysis patients include:
Studies have documented incidence rates ranging from:
Clinical Profile of HCV-Infected Hemodialysis Patients
Clinical Presentation
- Majority of HCV-infected hemodialysis patients are asymptomatic 2
- Signs of acute HCV infection are rarely recognized in this population 2
- Monthly ALT monitoring is recommended to detect potential new infections 1
Clinical Consequences
- Increased risk of cirrhosis and hepatocellular carcinoma 2, 3
- Higher overall mortality rates 2, 3
- Diminished quality of life scores 2
- Increased risk of hospitalization 2
- Potential progression of kidney disease in HCV-infected patients 1
Liver Disease Assessment
- All HCV-infected patients with CKD should be assessed for liver fibrosis 1
- Initial noninvasive evaluation of liver fibrosis is recommended 1
- Assessment for portal hypertension in patients with suspected advanced fibrosis (F3-F4) 1
Screening and Diagnosis Recommendations
Initial Screening
- Screen all patients upon initiation of in-center hemodialysis or transfer from another facility 1, 2
- Use NAT alone or immunoassay followed by NAT if positive 1
- Screen all patients upon initiation of peritoneal dialysis or home hemodialysis 1
- Screen all patients at the time of evaluation for kidney transplantation 1
Ongoing Surveillance
- Screen for HCV infection with immunoassay or NAT every 6 months in hemodialysis patients 1, 2
- In units with new HCV infection, test all patients and increase frequency of subsequent testing 1
- Patients with resolved HCV infection should undergo repeat testing every 6 months using NAT to detect possible re-infection 1
- Samples should be drawn before dialysis, as hemodialysis reduces viremia levels 1, 2
Laboratory Monitoring
- Check ALT levels upon initiation of in-center hemodialysis or transfer from another facility 1
- Monthly ALT monitoring is recommended for hemodialysis patients 1
Prevention and Control Measures
- Report any new HCV infection to appropriate public health authorities 1, 2, 4
- Strict adherence to infection control practices is essential:
- Physical separation of HCV-positive and HCV-negative patients may help control transmission in high-prevalence units 5
Treatment Considerations
- All patients with CKD on dialysis with HCV should be evaluated for direct-acting antiviral (DAA) therapy 1
- Studies show high SVR12 rates (93.8%) with DAA regimens in hemodialysis patients, including those with compensated cirrhosis 7
- Treatment selection should consider prior treatment history, drug-drug interactions, and stage of liver disease 1
Additional Recommendations
- All CKD patients with history of HCV infection should be:
Common Pitfalls in HCV Management in Hemodialysis Units
- Failure to implement routine screening protocols
- Inadequate infection control practices
- Delayed reporting of new infections
- Insufficient staff education on HCV transmission prevention
- Failure to recognize asymptomatic infections due to lack of routine screening
The implementation of comprehensive screening protocols, strict infection control practices, and prompt management of new cases are essential strategies for reducing the prevalence and impact of HCV infection in hemodialysis units.