Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C in Chronic Kidney Disease

Publication Date: October 1, 2018
Last Updated: March 14, 2022

Detection and evaluation of HCV in CKD

Screening patients with chronic kidney disease (CKD) for hepatitis C virus (HCV) infection

We recommend screening all patients for HCV infection at the time of initial evaluation of CKD. (Level 1, C)
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We recommend using an immunoassay followed by nucleic acid testing (NAT) if immunoassay is positive. (Level 1, A)
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We recommend screening all patients for HCV infection upon initiation of in-center hemodialysis or upon transfer from another dialysis facility or modality. (Level 1, A)
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We recommend using NAT alone or an immunoassay followed by NAT if immunoassay is positive. (Level 1, A)
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We suggest screening all patients for HCV infection upon initiation of peritoneal dialysis or home hemodialysis. (Level 2, D)
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We recommend screening all patients for HCV infection at the time of evaluation for kidney transplantation. (Level 1, A)
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Follow-up HCV screening of in-center hemodialysis patients

We recommend screening for HCV infection with immunoassay or NAT in in-center hemodialysis patients every 6 months. (Level 1, B)
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Report any new HCV infection identified in a hemodialysis patient to the appropriate public health authority. (NG, )
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In units with a new HCV infection, we recommend all patients be tested for HCV infection and the frequency of subsequent HCV testing be increased. (Level 1, A)
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We recommend that hemodialysis patients with resolved HCV infection undergo repeat testing every 6 months using NAT to detect possible re-infection. (Level 1, B)
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We suggest that patients have serum alanine aminotransferase (ALT) level checked upon initiation of incenter hemodialysis or upon transfer from another facility. (Level 2, B)
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We suggest hemodialysis patients have ALT level checked monthly. (Level 2, B)
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Liver testing in patients with CKD and HCV infection

We recommend assessing HCV-infected patients with CKD for liver fibrosis. (Level 1, A)
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We recommend an initial noninvasive evaluation of liver fibrosis. (Level 1, B)
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When the cause of liver disease is uncertain or noninvasive testing results are discordant, consider liver biopsy. (NG, )
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We recommend assessment for portal hypertension in CKD patients with suspected advanced fibrosis. (Level 1, A)
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Other testing of patients with HCV infection

We recommend assessing all patients for kidney disease at the time of HCV infection diagnosis. (Level 1, A)
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Screen for kidney disease with urinalysis and estimated glomerular filtration rate (eGFR) (NG, )
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If there is no evidence of kidney disease at initial evaluation, patients who remain NAT-positive should undergo repeat screening for kidney disease. (NG, )
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We recommend that all CKD patients with a history of HCV infection, whether NAT-positive or not, be followed up regularly to assess progression of kidney disease. (Level 1, A)
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We recommend that all CKD patients with a history of HCV infection, whether NAT-positive or not, be screened, and, if appropriate, vaccinated against hepatitis A virus (HAV) and hepatitis B virus (HBV), and screened for human immunodeficiency virus (HIV). (Level 1, A)
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Recommendation Grading

Overview

Title

Hepatitis C in Chronic Kidney Disease

Authoring Organizations

Kidney Disease Improving Global Outcomes

National Kidney Foundation

Publication Month/Year

October 1, 2018

Last Updated Month/Year

April 13, 2023

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Prevention, Treatment

Diseases/Conditions (MeSH)

D006526 - Hepatitis C

Keywords

chronic kidney disease, hepatitis C virus, hemodialysis

Methodology

Number of Source Documents
356
Literature Search Start Date
January 1, 2008
Literature Search End Date
July 31, 2018
Description of External Review Process
The guideline had undergone external public review in February 2017
Description of Public Comment Process
Public review comments were compiled and fed back to the Work Group, which considered comments in its revision of the guideline.
Specialties Involved
Family Medicine, Hepatology, Infectious Disease, Internal Medicine General, Nephrology, Pediatrics, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Hepatology, Pediatrics, Pediatrics, Pediatrics
Description of Systematic Review
Yes - Refer to Supplement B 3.1. The Work Group Co-Chairs and the ERT defined the overall scope and goals of the guideline (including a list of critical and important interventions and outcomes) and then drafted a preliminary list of topics and key clinical questions. The list of research and recommendation topics was based on the original KDIGO guideline on HCV which the ERT also had helped to develop (when it was based at Tufts Medical Center in Boston, MA). The Work Group and ERT further developed and refined each topic and its eligibility criteria, literature search strategies, and data extraction
List of Questions
Yes - Refer to Supplement B 2.5.3, 2.5.4, and 2.5.5. Formation of Questions of Interest. Questions of interest were formulated according to the PICODD criteria (population, intervention, comparator, outcome, study design, and duration of follow-up). Details of the PICODD criteria are presented in Table 8. Ranking of outcomes. The Work Group ranked outcomes of interest on the basis of their importance for informing clinical decision
Description of Study Criteria
Yes - Refer to Supplement B 2.6.2, 2.6.3. Refer to Figure 2 page 144.
Description of Search Strategy
Yes - Refer to Supplement B 2.6.4. Topics were triaged either to (i) systematic review, (ii) systematic search followed by narrative summary, or (iii) narrative summary. For systematic reviews, we searched PubMed, Embase, Cochrane Central Registry for trials, and Cochrane database of systematic reviews. Screening criteria for this and other topics are outlined in the Methods for Guideline Development chapter.
Description of Study Selection
Yes - Refer to Supplement B 2.6.5, 2.6.6, and 2.6.7. Refer to Section “Literature Searches and Article Selection” starting on page 142.
Description of Evidence Analysis Methods
Yes - Refer to Supplement B 2.6.8 and 2.6.9. Summary tables. Summary tables were developed for each reviewed topic. Summary tables contain outcomes of interest, relevant population characteristics, description of intervention and comparator (or predictor), results, and quality grading for each outcome. Categorical outcomes and continuous outcomes were tabulated separately. Work Group members reviewed and confirmed all summary table data and quality assessments. Summary tables are available as supplementary material at www.kisupplements.org. Evidence profiles. Evidence profiles were constructed to assess the quality and record quality grades and descriptions of effect (or association) for each outcome across studies, as well as the quality of overall evidence and description of net benefits or harms of the intervention or comparator across all outcomes. These profiles aim to make the evidence synthesis process transparent. Decisions in the evidence profiles were based on data from the primary studies listed in corresponding summary tables and on judgments of the ERT and Work Group. When the body of evidence for a particular comparison of interest consisted of 2 or fewer studies, the summary table provided the final level of synthesis and an evidence profile was not generated. Each evidence profile was initially constructed by the ERT and then reviewed, edited, and approved by the Work Group. The work products created by the ERT for summarizing the evidence base are listed in Table 10, together with the number of included studies.
Description of Evidence Grading
Yes - Refer to Supplement B 5.0. A: High quality of evidence. The Work Group is confident that the true effect lies close to that of the estimate of the effect. B: Moderate quality of evidence. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. C: Low quality of evidence. The true effect may be substantially different from the estimate of the effect. D: Very low quality of evidence. The estimate of effect is very uncertain and often will be far from the truth
Description of Recommendation Grading
Yes – Refer to Supplement B 5.0. KDIGO uses a GRADE Methodology. Level 1. Strong Recommendation: “We Recommend.” Clinicians: most patients should receive the recommended course of action. Level 2 Conditional Recommendation: “We Suggest.” Clinicians: Different choices will be appropriate for different patients. Each patient needs help to arrive at a management decision consistent with her or his values and preferences.
Description of Funding Source
Yes – Refer to Supplement B 2.0. This guideline is funded by KDIGO. Financial disclosures of Work Group members are published in Biographic and Disclosure Information section of the guideline.
Company/Author Disclosures
Yes – Refer to Supplement B 2.0. Refer to Supplement B 2.0. Financial disclosures of Work Group members are published in Biographic and Disclosure Information section of the guideline.
Percentage of Authors Reporting COI
100