Hepatitis C Infection in Dialysis [1 ed.] 9781617610332, 9781617288517

Citation preview

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved. Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved. Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

NEPHROLOGY RESEARCH AND CLINICAL DEVELOPMENTS

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

HEPATITIS C INFECTION IN DIALYSIS

No part of this digital document may be reproduced, stored in a retrieval system or transmitted in any form or by any means. The publisher has taken reasonable care in the preparation of this digital document, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained herein. This digital document is sold with the clear understanding that the publisher is not engaged in rendering legal, medical or any other professional services.

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

NEPHROLOGY RESEARCH AND CLINICAL DEVELOPMENTS Additional books in this series can be found on Nova’s website under the Series tab.

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Additional E-books in this series can be found on Nova’s website under the E-books tab.

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

NEPHROLOGY RESEARCH AND CLINICAL DEVELOPMENTS

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

HEPATITIS C INFECTION IN DIALYSIS

MAGID A. FAHIM AND

DAVID W. JOHNSON

Nova Biomedical Books New York

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher.

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Library of Congress Cataloging-in-Publication Data

Available upon Request ISBN: 978-1-61761-033-2 (eBook)

Published by Nova Science Publishers, Inc.  New York

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Contents Preface

vii

Introduction

ix

Chapter I

Epidemiology

1

Chapter II

Risk Factors for HCV Acquisition in Haemodialysis Patients

5

Prevention of HCV Transmission in Haemodialysis Units

11

Chapter IV

Diagnosis, Screening and Evaluation

15

Chapter V

Hepatic Pathology and Complications

21

Chapter VI

Treatment and Monitoring

23

Chapter VII

Outcomes

31

Chapter VIII

Conclusion

33

Chapter III

References

35

Index

43

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved. Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Preface Hepatitis C virus (HCV) infection affects more than 170 million people worldwide and is recognised as both a cause and consequence of end-stage kidney failure. The incidence rates of HCV infection are considerably higher in dialysis patients than in the general population and are 3-fold higher in haemodialysis patients than peritoneal dialysis patients. Risk factors for HCV infection in dialysis patients include blood transfusion number, haemodialysis duration, dialysis unit HCV prevalence, prior kidney transplantation, intravenous drug use, male gender and older age. Improved infection control practices for HCV-infected patients, such as staff barrier protection, environmental hygiene precautions, medication / equipment and waste handling procedures, and avoidance of blood transfusions have been associated with an appreciable reduction in HCV occurrence in dialysis units in the past decade, although prevalence rates as high as 17% continue to be reported in some Asia-Pacific countries. HCV infection in the setting of dialysis poses significant diagnostic and management problems because of impaired diagnostic value of some tests, higher risks of drug toxicities from antiviral therapies (especially ribavirin), and a general lack of clinical trials in this patient population. Consequently, the presence of HCV in dialysis patients correlates with substantially increased morbidity and mortality. The aim of this article is to review the epidemiology of HCV in dialysis and to discuss strategies for screening, transmission prevention, treatment and evaluation/management prior to kidney transplantation.

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved. Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Introduction Hepatitis C virus (HCV) infection is an important cause of infectious disease globally; the World Health Organization estimates that between 2-3% of the world’s population have been infected with the virus, equating to 123 – 170 million chronic carriers worldwide [1-3]. Chronic kidney disease is a well documented potential consequence of HCV infection, which is able to induce renal injury through a variety of mechanisms, most commonly membranoproliferative glomerulonephritis, but also amyloidosis [4], and exacerbation of hypertension and insulin resistance [5]. In addition to being a complication of HCV infection, end stage renal disease and dialysis represent important risk factors for acquiring HCV infection through their associated comorbidities and environmental exposure. In this text we review the epidemiology and risk factors for transmission of HCV in the dialysis population, and discuss strategies for screening and diagnosis, transmission prevention, treatment and pre-renal transplant evaluation and management.

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved. Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Chapter I

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Epidemiology A large number of studies have examined the epidemiology of HCV infection in the dialysis population and a selection of these are summarized in Table 1. Several important observations can be made. Firstly, concordant with the distribution of HCV infection in the non-dialysis population, these reports reveal large variations in the prevalence and incidence of HCV infection among dialysis patients by country. In addition, large variations in prevalence have also been documented between individual dialysis units and/or regions within a single country. For instance, in the 2002 annual report of the Centers for Disease Control and Prevention (CDC) encompassing 263,820 haemodialysis patients from 4,035 units across the USA, the authors reported HCV prevalence rates ranging from 5.5% to 9.8% by region [6]. Similarly a survey of 3,926 patients from 58 public haemodialysis units across three regions in Italy revealed a significant difference in HCV prevalence of 33% vs. 23% by region [7]. Finally, Hinrichsen and colleagues reported HCV point prevalence values ranging from 0 - 22.5% in a survey of 43 German haemodialysis units involving 2,796 patients [8]. These regional/unit differences likely reflect differences in the prevalence of HCV infection at dialysis commencement, patient demographics among various units, and differences in infection control practices among individual units. Epidemiologic studies have also consistently reported a higher prevalence of HCV infection among dialysis patients – especially haemodialysis patients – compared with the general population. For example, Johnson et al reported a median HCV prevalence of 7.9% among 173,788 haemodialysis patients in seven countries across the Asia-Pacific region compared with 1 - 2.9% in the general population of those countries [9]. Similarly, a report from the Dialysis

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

2

Magid A. Fahim and David W. Johnson

Outcomes and Practice Patterns Study (DOPPS) involving a random sample of 8,615 patients from 308 haemodialysis units across the USA, Europe and Japan found a median HCV prevalence of 10.5% among the haemodialysis population compared with 1 - 2.9% in the non-dialysis population [10, 11]. There are two explanations for this finding – firstly, HCV infection is in itself a risk factor for end-stage renal disease, such that the prevalence of HCV among individuals with chronic kidney disease prior to dialysis commencement also exceeds that of the general population. This was demonstrated in a registry analysis involving 6,412 Italian haemodialysis patients in 75 centres, with the authors reporting a HCV prevalence of 7.1 10% in incident dialysis patients prior to dialysis commencement compared with 1 - 1.9% in the general population [12]. Secondly, end-stage renal disease and dialysis – especially haemodialysis – are well documented risk factors for acquiring HCV infection, contributing to the over-representation of HCV infection in this group. This is discussed in more detail below. In addition to estimating the point prevalence and incidence of HCV infection, longitudinal epidemiological studies have also examined trends in these parameters over time, and have largely demonstrated a significant decline in the prevalence of HCV infection through the 1990’s. As examples, HCV prevalence among dialysis patients in Australia and New Zealand declined from 5.1% in 1995 to 2.2% in 2006 [9], while among haemodialysis units in the USA, prevalence fell from 25.7% in 1995 to 7.8% in 2002 despite an increase in the proportion of units adopting regular testing practices [6]. Similar trends in prevalence have also been demonstrated in most European countries, with HCV prevalence among Belgian haemodialysis patients falling from 13.5% in 1991 to 6.8% in 2000 [20], and from 30.6% in 1995 to 15.1% in 2003 among Italian haemodialysis patients [12]. The observed fall in HCV prevalence is likely related to three main factors – firstly the universal screening of blood donors and allografts for HCV infection in the early 1990s, reducing infection through blood product administration and transplantation, secondly the reduced need for blood transfusions to treat anaemia following the introduction of erythropoiesis-stimulating agents (ESA’s), and finally the increasing adoption of infection control practices in dialysis units. In contrast to the decline in prevalence, the incidence of HCV seroconversion among dialysis patients has remained fairly static over last decade [9, 12, 20], a factor largely attributed to persisting nosocomial transmission within dialysis units and highlighting the need for strict adherence to infection control practices and regular audit of compliance with these recommendations.

Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Table 1. Summary of selected epidemiological surveys of HCV infection prevalence and incidence among dialysis patients. HD – haemodialysis, PD – peritoneal dialysis, N/A – data not available Author

Number of Units Surveyed

Number of Patients

Countries Surveyed

Johnson et al[9]

National Registry Data for all countries except China

173,788 HD 27,802 PD

Fissell et al[10]

308

8,615 HD

Maia et al[13] Otedo et al[14] Cassidy et al[15] Shamshirsaz et al[16] Huraib et al[17] Gohar et al[18] Gorriz et al[19]

1 1 2 12 22 1 5

395 HD 100 HD & PD 103 HD 593 HD 1147 HD 64 HD 255 PD

China (Shanghai) Malaysia Taiwan Hong Kong Thailand Japan Korea Australia & New Zealand USA UK France Germany Italy Japan Spain Brazil Kenya South Africa Iran Saudi Arabia Egypt Spain

Prevalence (%) HD 17.0 14.0 9.4 4.3 4.3 3.6 3.6 2.3

PD 4.3 5.1 3.4 1.9 6.0 0.9 0.9 1.7

Incidence (% per 100 patient years) HD PD N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 0.1 0.03

14.4 2.7 14.7 3.9 22.2 19.9 22.2 13.9 5.0 21.0 9.0 62.6 87.5 N/A

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 11.4

3.1 1.1 1.9 1.7 3.6 3.1 3.0 0.8 N/A N/A 1.3 – 5.0 N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved. Hepatitis C Infection in Dialysis, Nova Science Publishers, Incorporated, 2010. ProQuest Ebook Central,

Chapter II

Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

Risk Factors for HCV Acquisition in Haemodialysis Patients Epidemiological reports serve not only to compare geographic and temporal patterns of HCV infection, but also provide a tool for the identification of risk factors for HCV infection acquisition from which infection control policies can be formulated and thereafter assessed. In this respect, the wide variation in the scope of these reports is particularly important, with the most inclusive reports providing the most reliable information on both epidemiological data and the predictors of infection. In this section we review and discuss risk factors for acquiring HCV infection in the dialysis population.

Demographic Factors The DOPPS survey of 308 US, European and Japanese haemodialysis units [10] found that HCV prevalence among haemodialysis patients was significantly predicted by Black race (OR 1.93, P