Hepatitis C virus (HCV) infection is of particular concern in patients with chronic kidney disease (CKD). There is a much higher prevalence of HCV infection in the CKD/end-stage kidney disease (ESKD) population than is found in the general population. HCV can also cause kidney disease.
Global evidence-based clinical practice guidelines for the diagnosis and management of HCV in kidney patients were published by Kidney Disease Improving Global Outcomes (KDIGO) in 2018. To provide guidance to nephrologists on how these recommendations should be applied and implemented in the US, the National Kidney Foundation (NKF) has provided commentary in the “National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) Commentary on the Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Prevention, Diagnosis, Evaluation and Treatment of Hepatitis C.”
The guidelines cover five key aspects of care of HCV-infected CKD patients: diagnosis, treatment, prevention of transmission in dialysis units, management of kidney transplant patients, and management of HCV-associated kidney diseases.
NKF’s KDOQI commentary, which will be published online in the American Journal of Kidney Disease (AJKD) April 9, is generally supportive of applying the guideline in U.S. practice. However, NKF’s team challenged important components of that guideline in the context of additional research and experience. They questioned the directive about allocation of HCV-infected organs only to recipients who are also infected with HCV.
NKF’s team of investigators believe that “in an era where highly effective direct acting antiviral agents are available that eradicate the virus in virtually all patients, one must consider why these kidneys should not be offered to HCV negative patients on the waitlist as well,” said lead investigator David Roth, MD, of the Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine.
“This commentary is a great example of how KDOQI can assist practitioners in deciding how best to implement a global guideline in the US clinical practice environment,” said Kerry Willis, PhD, NKF Chief Scientific Officer.
“The authors wrote this commentary to be of value to practicing nephrologists who want to distill the KDIGO guideline into those important aspects that would be relevant to their practice,” Dr. Roth said. “One could choose to read the entire manuscript or just focus on those areas that are relevant to a particular patient or their practice as a whole.”
NKF gathered a team of experts in nephrology, transplantation, hepatology, and infectious diseases to analyze the KDIGO guidelines and provided the most up-to-date perspectives on the evolving field.