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Hepatitis C virus infection in patients on maintenance dialysis

Authors
Svetlozar Natov, MD
Brian JG Pereira, MD
Section Editors
Steve J Schwab, MD
Martin S Hirsch, MD
Deputy Editor
Alice M Sheridan, MD

INTRODUCTION

Hepatitis C virus (HCV) infection is common and associated with significant morbidity and mortality among dialysis patients.

This topic reviews epidemiology of HCV infection among dialysis patients, including risk factors for and prevention of HCV transmission within dialysis units. The treatment of HCV infection among patients with reduced renal function, including those on dialysis, is discussed elsewhere. (See "Treatment of chronic hepatitis C infection in adults with renal impairment", section on 'Severe renal impairment or dialysis'.)

General issues related to HCV infection among transplant kidney donors and recipients and recurrent or de novo HCV-related renal disease in transplant recipients are discussed elsewhere. (See "Hepatitis C virus infection in kidney donors" and "Hepatitis C infection in kidney transplant candidates and recipients".)

EPIDEMIOLOGY

HCV infection is more common in dialysis patients than in healthy populations. The best data regarding prevalence among dialysis patients were provided by Dialysis Outcomes and Practice Patterns Study (DOPPS), which was a prospective, observational study that reported the prevalence of HCV among adult hemodialysis patients randomly selected from 308 representative dialysis facilities in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States [1]. The overall prevalence was 13.5 percent (compared with global prevalence in the general population of approximately 3 percent). (See "Epidemiology and transmission of hepatitis C virus infection", section on 'Global distribution'.)

DOPPS reported a wide variation among countries, from 2.6 to 22.9 percent. From various studies, the reported prevalence of anti-HCV antibodies among dialysis patients in different countries is:

      

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Literature review current through: Nov 2016. | This topic last updated: Fri Dec 05 00:00:00 GMT 2014.
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References
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  1. Fissell RB, Bragg-Gresham JL, Woods JD, et al. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Int 2004; 65:2335.
  2. Finelli L, Miller JT, Tokars JI, et al. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial 2005; 18:52.
  3. Fabrizi F, Lunghi G, Raffaele L, et al. Serologic survey for control of hepatitis C in haemodialysis patients: third-generation assays and analysis of costs. Nephrol Dial Transplant 1997; 12:298.
  4. Biamino E, Caligaris F, Ferrero S, et al. [Prevalence of anti-HCV antibody positivity and seroconversion incidence in hemodialysis patients]. Minerva Urol Nefrol 1999; 51:53.
  5. Di Napoli A, Pezzotti P, Di Lallo D, et al. Epidemiology of hepatitis C virus among long-term dialysis patients: a 9-year study in an Italian region. Am J Kidney Dis 2006; 48:629.
  6. Couroucé AM, Bouchardeau F, Chauveau P, et al. Hepatitis C virus (HCV) infection in haemodialysed patients: HCV-RNA and anti-HCV antibodies (third-generation assays). Nephrol Dial Transplant 1995; 10:234.
  7. Covic A, Iancu L, Apetrei C, et al. Hepatitis virus infection in haemodialysis patients from Moldavia. Nephrol Dial Transplant 1999; 14:40.
  8. Othman B, Monem F. Prevalence of antibodies to hepatitis C virus among hemodialysis patients in Damascus, Syria. Infection 2001; 29:262.
  9. Kamar N, Ribes D, Izopet J, Rostaing L. Treatment of hepatitis C virus infection (HCV) after renal transplantation: implications for HCV-positive dialysis patients awaiting a kidney transplant. Transplantation 2006; 82:853.
  10. Tokars JI, Miller ER, Alter MJ, Arduino MJ. National surveillance of dialysis associated diseases in the United States, 1995. ASAIO J 1998; 44:98.
  11. Geerlings W, Tufveson G, Ehrich JH, et al. Report on management of renal failure in Europe, XXIII. Nephrol Dial Transplant 1994; 9 Suppl 1:6.
  12. Valderrábano F, Jones EH, Mallick NP. Report on management of renal failure in Europe, XXIV, 1993. Nephrol Dial Transplant 1995; 10 Suppl 5:1.
  13. Jadoul M, Poignet JL, Geddes C, et al. The changing epidemiology of hepatitis C virus (HCV) infection in haemodialysis: European multicentre study. Nephrol Dial Transplant 2004; 19:904.
  14. Tokars JI, Miller ER, Alter MJ, Arduino MJ. National surveillance of dialysis-associated diseases in the United States, 1997. Semin Dial 2000; 13:75.
  15. Baid-Agrawal S, Schindler R, Reinke P, et al. Prevalence of occult hepatitis C infection in chronic hemodialysis and kidney transplant patients. J Hepatol 2014; 60:928.
  16. Pereira BJ, Levey AS. Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int 1997; 51:981.
  17. Espinosa M, Martn-Malo A, Ojeda R, et al. Marked reduction in the prevalence of hepatitis C virus infection in hemodialysis patients: causes and consequences. Am J Kidney Dis 2004; 43:685.
  18. Natov SN, Lau JY, Bouthot BA, et al. Serologic and virologic profiles of hepatitis C infection in renal transplant candidates. New England Organ Bank Hepatitis C Study Group. Am J Kidney Dis 1998; 31:920.
  19. Donahue JG, Muñoz A, Ness PM, et al. The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med 1992; 327:369.
  20. Cendoroglo Neto M, Draibe SA, Silva AE, et al. Incidence of and risk factors for hepatitis B virus and hepatitis C virus infection among haemodialysis and CAPD patients: evidence for environmental transmission. Nephrol Dial Transplant 1995; 10:240.
  21. Weinstein T, Tur-Kaspa R, Chagnac A, et al. Hepatitis C infection in dialysis patients in Israel. Isr Med Assoc J 2001; 3:174.
  22. dos Santos JP, Loureiro A, Cendoroglo Neto M, Pereira BJ. Impact of dialysis room and reuse strategies on the incidence of hepatitis C virus infection in haemodialysis units. Nephrol Dial Transplant 1996; 11:2017.
  23. Jadoul M, Cornu C, van Ypersele de Strihou C. Incidence and risk factors for hepatitis C seroconversion in hemodialysis: a prospective study. The UCL Collaborative Group. Kidney Int 1993; 44:1322.
  24. Petrosillo N, Gilli P, Serraino D, et al. Prevalence of infected patients and understaffing have a role in hepatitis C virus transmission in dialysis. Am J Kidney Dis 2001; 37:1004.
  25. Bergman S, Accortt N, Turner A, Glaze J. Hepatitis C infection is acquired pre-ESRD. Am J Kidney Dis 2005; 45:684.
  26. DuBois DB, Gretch D, dela Rosa C, et al. Quantitation of hepatitis C viral RNA in sera of hemodialysis patients: gender-related differences in viral load. Am J Kidney Dis 1994; 24:795.
  27. Jeffers LJ, Perez GO, de Medina MD, et al. Hepatitis C infection in two urban hemodialysis units. Kidney Int 1990; 38:320.
  28. Alter MJ, Margolis HS, Krawczynski K, et al. The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic non-A, non-B Hepatitis Study Team. N Engl J Med 1992; 327:1899.
  29. Stuyver L, Claeys H, Wyseur A, et al. Hepatitis C virus in a hemodialysis unit: molecular evidence for nosocomial transmission. Kidney Int 1996; 49:889.
  30. Halfon P, Roubicek C, Gerolami V, et al. Use of phylogenetic analysis of hepatitis C virus (HCV) hypervariable region 1 sequences to trace an outbreak of HCV in an autodialysis unit. J Clin Microbiol 2002; 40:1541.
  31. Grethe S, Gemsa F, Monazahian M, et al. Molecular epidemiology of an outbreak of HCV in a hemodialysis unit: direct sequencing of HCV-HVR1 as an appropriate tool for phylogenetic analysis. J Med Virol 2000; 60:152.
  32. Olmer M, Bouchouareb D, Zandotti C, et al. Transmission of the hepatitis C virus in an hemodialysis unit: evidence for nosocomial infection. Clin Nephrol 1997; 47:263.
  33. Sypsa V, Psichogiou M, Katsoulidou A, et al. Incidence and patterns of hepatitis C virus seroconversion in a cohort of hemodialysis patients. Am J Kidney Dis 2005; 45:334.
  34. Jadoul M, Fabrizi F. What are the management issues for hepatitis C in dialysis patients?: epidemiology and prevention of hepatitis C virus transmission in the hemodialysis setting. Semin Dial 2014; 27:449.
  35. Kiyosawa K, Sodeyama T, Tanaka E, et al. Hepatitis C in hospital employees with needlestick injuries. Ann Intern Med 1991; 115:367.
  36. Mitsui T, Iwano K, Masuko K, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992; 16:1109.
  37. Alter MJ. The epidemiology of acute and chronic hepatitis C. Clin Liver Dis 1997; 1:559.
  38. Lanphear BP, Linnemann CC Jr, Cannon CG, et al. Hepatitis C virus infection in healthcare workers: risk of exposure and infection. Infect Control Hosp Epidemiol 1994; 15:745.
  39. Puro V, Petrosillo N, Ippolito G. Risk of hepatitis C seroconversion after occupational exposures in health care workers. Italian Study Group on Occupational Risk of HIV and Other Bloodborne Infections. Am J Infect Control 1995; 23:273.
  40. Okuda K, Hayashi H, Kobayashi S, Irie Y. Mode of hepatitis C infection not associated with blood transfusion among chronic hemodialysis patients. J Hepatol 1995; 23:28.
  41. Gilli P, Moretti M, Soffritti S, et al. Non-A, non-B hepatitis and anti-HCV antibodies in dialysis patients. Int J Artif Organs 1990; 13:737.
  42. 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.
  43. Alfurayh O, Sabeel A, Al Ahdal MN, et al. Hand contamination with hepatitis C virus in staff looking after hepatitis C-positive hemodialysis patients. Am J Nephrol 2000; 20:103.
  44. Niu MT, Alter MJ, Kristensen C, Margolis HS. Outbreak of hemodialysis-associated non-A, non-B hepatitis and correlation with antibody to hepatitis C virus. Am J Kidney Dis 1992; 19:345.
  45. Garcia-Valdescasas J, Bernal MC, Cerezo S, et al. Strategies to reduce the transmission of HCV infection in hemodialysis (HD) units (abstract). J Am Soc Nephrol 1993; 4:347.
  46. Jadoul M, Cornu C, van Ypersele de Strihou C. Universal precautions prevent hepatitis C virus transmission: a 54 month follow-up of the Belgian Multicenter Study. The Universitaires Cliniques St-Luc (UCL) Collaborative Group. Kidney Int 1998; 53:1022.
  47. Froio N, Nicastri E, Comandini UV, et al. Contamination by hepatitis B and C viruses in the dialysis setting. Am J Kidney Dis 2003; 42:546.
  48. Brugnano R, Francisci D, Quintaliani G, et al. Antibodies against hepatitis C virus in hemodialysis patients in the central Italian region of Umbria: evaluation of some risk factors. Nephron 1992; 61:263.
  49. Mitwalli A, al-Mohaya S, al Wakeel J, et al. Hepatitis C in chronic renal failure patients. Am J Nephrol 1992; 12:288.
  50. Rais-Jalali G, Khajehdehi P. Anti-HCV seropositivity among haemodialysis patients of Iranian origin. Nephrol Dial Transplant 1999; 14:2055.
  51. Vagelli G, Calabrese G, Guaschino R, Gonella M. Effect of HCV+ patients isolation on HCV infection incidence in a dialysis unit. Nephrol Dial Transplant 1992; 7:1070.
  52. Calabrese G, Vagelli G, Guaschino R, Gonella M. Transmission of anti-HCV within the household of haemodialysis patients. Lancet 1991; 338:1466.
  53. Taskapan H, Oymak O, Dogukan A, Utas C. Patient to patient transmission of hepatitis C virus in hemodialysis units. Clin Nephrol 2001; 55:477.
  54. Taal MW, van Zyl-Smit R. Hepatitis C virus infection in chronic haemodialysis patients--relationship to blood transfusions and dialyser re-use. S Afr Med J 2000; 90:621.
  55. Hubmann R, Zazgornik J, Gabriel C, et al. Hepatitis C virus--does it penetrate the haemodialysis membrane? PCR analysis of haemodialysis ultrafiltrate and whole blood. Nephrol Dial Transplant 1995; 10:541.
  56. Caramelo C, Navas S, Alberola ML, et al. Evidence against transmission of hepatitis C virus through hemodialysis ultrafiltrate and peritoneal fluid. Nephron 1994; 66:470.
  57. Noiri E, Nakao A, Oya A, et al. Hepatitis C virus in blood and dialysate in hemodialysis. Am J Kidney Dis 2001; 37:38.
  58. Lombardi M, Cerrai T, Dattolo P, et al. Is the dialysis membrane a safe barrier against HCV infection? Nephrol Dial Transplant 1995; 10:578.
  59. Castelnovo C, Sampietro M, De Vecchi A, et al. Diffusion of HCV through peritoneal membrane in HCV positive patients treated with continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 1997; 12:978.
  60. Recommendations for preventing transmission of infections among chronic hemodialysis patients. MMWR Recomm Rep 2001; 50:1.
  61. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008; :S1.
  62. Natov SN, Pereira BJG. Transmission of disease by organ transplantation. In: Organ and Tissue Donation for Transplantation, Chapman JD, Deierhoi M, Wight C (Eds), Edward Arnold, London 1996.
  63. Fabrizi F, Martin P, Dixit V, et al. Meta-analysis: Effect of hepatitis C virus infection on mortality in dialysis. Aliment Pharmacol Ther 2004; 20:1271.
  64. Terrault NA, Adey DB. The kidney transplant recipient with hepatitis C infection: pre- and posttransplantation treatment. Clin J Am Soc Nephrol 2007; 2:563.
  65. Fabrizi F, Martin P, Lunghi G, Locatelli F. Membrane compatibility, flux and HCV infection in dialysis patients: newer evidence. Int J Artif Organs 2000; 23:296.
  66. Stehman-Breen CO, Emerson S, Gretch D, Johnson RJ. Risk of death among chronic dialysis patients infected with hepatitis C virus. Am J Kidney Dis 1998; 32:629.
  67. Pereira BJ, Natov SN, Bouthot BA, et al. Effects of hepatitis C infection and renal transplantation on survival in end-stage renal disease. The New England Organ Bank Hepatitis C Study Group. Kidney Int 1998; 53:1374.
  68. Nakayama E, Akiba T, Marumo F, Sato C. Prognosis of anti-hepatitis C virus antibody-positive patients on regular hemodialysis therapy. J Am Soc Nephrol 2000; 11:1896.
  69. Seeff LB, Buskell-Bales Z, Wright EC, et al. Long-term mortality after transfusion-associated non-A, non-B hepatitis. The National Heart, Lung, and Blood Institute Study Group. N Engl J Med 1992; 327:1906.
  70. Marcelli D, Stannard D, Conte F, et al. ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. Kidney Int 1996; 50:1013.