Hepatitis C in CKD: Challenges and Opportunities

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HCV infection increases end-stage renal disease (ESRD) risk among patients with diabetes.

[Editor’s note: This review and commentary includes study data presented at the 53^rd Congress of the European Renal Association-European Dialysis & Transplant Association (ERA-EDTA 2016) in Vienna, Austria, May 21-24. 2016, and reflects discussions that took place at the congress.]

Infection with the hepatitis C virus (HCV) affects more than 170 million people worldwide. After acute infection, 80% to 85% of individuals do not clear the virus and progress to chronic infection and its associated complications.¹ The risk of liver-related complications such as cirrhosis and hepatocellular carcinoma is well known, but it has become apparent that HCV is also associated with extra-hepatic complications, including chronic kidney disease (CKD).

HCV and chronic kidney disease

According to a recent systematic review and meta-analysis, individuals who are seropositive for anti-HCV antibodies (HCV+) have a significant 23% greater relative risk of having and/or developing CKD compared with uninfected individuals.² At the 53^rd Congress of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) in Vienna, I advised delegates that chronic HCV infection should be seen as a metabolic disease that causes chronic systemic inflammation through direct viral effects on the vasculature and indirect effects via the immune system and the liver. The result is a pro-inflammatory state that increases the risk of atherosclerosis, cardiovascular disease, the metabolic syndrome, and diabetes.³ These are known risk factors for CKD in the general population, but a large cohort study in Taiwan concluded that there is a significant and independent association between HCV and CKD in the absence of traditional CKD risk factors.⁴