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Guidance for prevention, diagnosis, evaluation, treatment of hepatitis C virus in chronic kidney disease
The latest clinical practice guideline from the Kidney Disease: Improving Global Outcomes (KDIGO) organization offers guidance for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) in chronic kidney disease (CKD).
The guideline is a targeted update to 2018 recommendations on the same topic and was triggered by new data on antiviral treatment in patients with advanced stages of CKD, transplant of hepatitis C virus (HCV)-infected kidneys into uninfected recipients, and evolution of the viewpoint on the role of kidney biopsy in patients with kidney diseases caused by HCV. A synopsis of the guideline is published in Annals of Internal Medicine.
The 2022 updated guideline includes 63 total recommendations intended to assist clinicians in care of patients with HCV infection and CKD, including patients receiving dialysis and patients with a kidney transplant. Among key changes, the guideline recommends expanding treatment of HCV 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 patients with glomerulonephritis.
The synopsis includes several visual aids to help guide decision-making. These include a table comparing the changes between the 2018 and 2022 guidelines, a figure showing direct-acting antiviral (DAA) regimens with evidence of effectiveness for various chronic kidney disease (CKD) populations, and a figure describing indications for biopsy in patients with hepatitis C virus (HCV) and severe glomerulonephritis. KDIGO will assess the currency of its recommendations to determine if they need to be updated in the next 3 years.
More information: Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2022 Clinical Practice Guideline, Annals of Internal Medicine (2023). DOI: 10.7326/M23-2391
