Hepatitis C in dialysis patients.

Hepatitis C virus (HCV) remains prevalent in dialysis patients and is an important cause of liver disease in this population. A number of risk factors have been identified for spreading the HCV infection among dialysis patients, including the number of blood transfusions, the duration of dialysis, the mode of dialysis, and the prevalence of HCV infection in the dialysis unit. Difficulties in formulating policies regarding HCV infection in dialysis units arise because of the high prevalence of HCV infection in dialysis patients, the limitations of current tests in identifying these patients, and the uncertainties regarding the modes of transmission within dialysis unit. Little is known concerning the natural history of HCV infection in patients undergoing dialysis. This is due in part to an unrecognized onset of infection, the slow progression of hepatitis C viral disease, and the fact that infected dialysis patients may not have the time to become clinically apparent because of the overall shortened life-expectancy. The clinical course of HCV infection in dialysis patients is generally asymptomatic, and the progression of the disease is apparently benign. The mortality rate of infected dialysis patients is higher than in non-infected subjects, and this is not only due to the liver disease itself but also to cardiovascular disorders. Interferon alpha (standard or pegylated) is the current treatment of HCV infection in dialysis patients, with careful patient selection together with a close follow-up of the main side effect. HCV infected dialysis patients who are candidates for renal transplantation have to be treated before transplantation, since HCV infection has a negative impact on graft and patient survival and interferon therapy remains contraindicated after transplantation because of the serious risk of graft rejection.