Prevention, Diagnosis, Evaluation, and Treatment of Hepatitis C Virus Infection in Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2018 Clinical Practice Guideline

Abstract

Description: The Kidney Disease: Improving Global Outcomes (KDIGO) 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in chronic kidney disease (CKD) is an extensive update of KDIGO's 2008 guideline on HCV infection in CKD. This update reflects the major advances since the introduction of direct-acting antivirals (DAAs) in the management of HCV infection in the CKD population.

Methods: The KDIGO work group tasked with developing the HCV and CKD guideline defined the scope of the guideline, gathered evidence, determined topics for systematic review, and graded the quality of evidence previously summarized by the evidence review team. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to appraise the quality of evidence and rate the strength of the recommendations. Searches of the English-language literature were conducted through May 2017 and were supplemented with targeted searches for studies of DAA treatment and with abstracts from nephrology, hepatology, and transplantation conferences. A review process involving many stakeholders, subject matter experts, and industry and national organizations informed the guideline's final modification.

Recommendation: The updated guideline comprises 66 recommendations. This synopsis focuses on 32 key recommendations pertinent to the prevention, diagnosis, treatment, and management of HCV infection in adult CKD populations.

The first clinical practice guideline published by Kidney Disease: Improving Global Outcomes (KDIGO) was its 2008 guideline on the prevention, diagnosis, evaluation, and treatment of hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) (1, 2). In the subsequent 10 years, the development of direct-acting antivirals (DAAs), which enabled a greater than 95% rate of viral eradication in CKD populations infected with HCV, prompted KDIGO to update its 2008 guideline (3, 4).

The guideline's overall objective is to inform the management of HCV infection, including the use of DAAs in adults with CKD. Its target audience includes nephrologists, transplant physicians, hepatologists, infectious disease specialists, primary care physicians, and other practitioners caring for adults with HCV infection and CKD worldwide. Like the original 2008 HCV and CKD guideline, recommendations are divided into 5 chapters addressing the detection and evaluation of HCV in CKD, treatment of HCV infection in patients with CKD, prevention of HCV transmission in hemodialysis units, management of HCV-infected patients before and after kidney transplantation, and diagnosis and management of kidney diseases associated with HCV infection.

Within the guideline, recommendations for clinical practice, implementation, and future research are highlighted. The guideline seeks to provide comprehensive guidance encompassing all aspects of managing HCV infection in CKD populations (Appendix Figure) and considers implementation across international settings where HCV and CKD are encountered. The complete version is available at www.kdigo.org and includes 66 recommendations. This synopsis focuses on 32 key recommendations relevant to clinical practice regarding HCV infection in patients with CKD. The major topics of the remaining 34 recommendations include the prevention of HCV transmission in hemodialysis units, CKD testing in HCV-infected patients, performance characteristics of noninvasive tests of hepatic fibrosis, and decisions regarding liver–kidney versus kidney-only transplantation.