NDT Advance Access published online on February 8, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn608
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© The Author [2009]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Endorsement of the Kidney Disease Improving Global Outcomes (KDIGO) hepatitis C guidelines: a European Renal Best Practice (ERBP) position statement
1 University of Medicine "Gr T Popa" Iasi and Hospital "C. I. Parhon" Iasi 2 Hôpital Erasme, Département Médico-Chirurgical de Néphrologie, Dialyse et Transplantation, 808 Route de Lennik Brussels, Belgium 3 Huddinge University Hospital, Department of Clinical Science, Karolinska Institutet, Division of Renal Medicine, Huddinge/Stockholm, Sweden 4 University Hospital Ghent, Internal Medicine, De Pintelaan 185, 9000 Ghent, Belgium 5 Centre Hepato-Biliaire, Assistance Publique-Hôpitaux de Paris Hôpital Paul Brousse and Institut National de la Santé et la Recherche Médicale 785, Villejuif, France 6 University Hospital Ghent, Nephrology Department, De Pintelaan 185, 9000 Ghent, Belgium 7 Ospedali Riuniti, CNR IBIM Epidemiologia Clinica delle Malattie Renali e dellIpertensione Arteriosa e Unita Operativa, 89124 Reggio Cal, Italy 8 INSERM Unit 271, Internal Medicine, Lyon, France
Correspondence and offprint requests to: Adrian Covic, FRCP (London), University of Medicine "Gr T Popa" Iasi and Hospital "C. I. Parhon" Iasi. E-mail: acovic@xnet.ro
Keywords: Hepatitis C; guidelines; KDIGO; ERBP; interferon
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Introduction |
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Recently the Kidney Disease Improving Global Outcomes (KDIGO) initiative published ‘the first product of what has been an unprecedented undertaking of the renal community’ [1]: the first set of global nephrological guidelines devoted to prevention, diagnosis and treatment in hepatitis C [1]. Previously, the KDIGO Board had defined non-duplication of existing guidelines and priority to topics of worldwide interest as its primary goals. Ultimately, a major infectious disease hepatitis C (HCV) was considered as the first topic to be dealt with because ‘(i) of the larger number of available studies on the subject; (ii) HCV is an infection that can detrimentally affect patients throughout the spectrum of chronic kidney disease (CKD) and can itself cause kidney disease; and (iii) HCV is a problem of worldwide cli- nical relevance in developed and developing countries’ [2].
A group of experts was commissioned to develop a rigorous
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Guideline review, analysis and endorsement |
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General
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Guideline 1: detection and evaluation of HCV in CKD |
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Guideline 1.1: determining which CKD patients should be tested for HCV
Guideline 1.2: HCV testing for patients on maintenance haemodialysis
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What is the best overall strategy for HCV testing? |
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Guideline 2: treatment of HCV infection in patients with CKD |
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Guideline 2.1: evaluation of HCV-infected CKD patients for antiviral treatment
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Which patients should be treated? |
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Guideline 2.2: basing HCV treatment on CKD stages
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Standard IFN versus pegylated IFN? |
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Treatment with IFN + ribavirin? |
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Guideline 2.3: monitoring the response to HCV treatment in CKD patients
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Guideline 3: preventing HCV transmission in haemodialysis units |
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Guideline 3.1: haemodialysis units should ensure implementation of, and adherence to, strict infection-control procedures designed to prevent transmission of blood-borne pathogens, including HCV. (Strong)
Guideline 3.2: infection-control procedures should include hygienic precautions (tables 18 and 19) that effectively prevent the transfer of blood—or fluids contaminated with blood—between patients, either directly or via contaminated equipment or surfaces. (Strong)
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Lack of KDIGO guidelines for peritoneal dialysis patients |
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Specific recommendations for PD patients
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Isolation of HCV-positive HD patients |
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Guideline 4: management of HCV-infected patients before and after kidney transplantation |
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Guideline 4.1: evaluation and management of kidney transplant candidates regarding HCV infection
Guideline 4.2: use of kidneys from HCV-infected donors
Guideline 4.3: use of maintenance immunosuppressive regimens
Guideline 4.4: management of HCV-related complications in kidney transplant recipients
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Should all HCV-infected kidney transplant candidates be considered for treatment with IFN before transplantation? |
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Should all HCV-infected kidney transplant candidates undergo a liver biopsy before transplantation? |
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What is the optimal strategy for IFN therapy for HCV-infected transplant candidates who return to dialysis with a failed allograft? |
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Guideline 5: diagnosis and management of kidney diseases associated with HCV infection |
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Future research areas relevant to the European perspective |
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European hepatitis C guideline implementation |
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Appendix 1. Hepatitis C in peritoneal dialysis: practice suggestions from the ERBP Work Group |
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A.1. Testing for hepatitis C in PD patients
A.2. Place of PD in hepatitis C negative patients
A.3. Handling of spent peritoneal dialysate
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  R. Vanholder, D. Abramowicz, J. B. Cannata-Andia, V. Cocchi, P. Cochat, A. Covic, K.-U. Eckardt, D. Fouque, O. Heimburger, S. Jenkins, et al. The future of European Nephrology 'Guidelines'--a declaration of intent by European Renal Best Practice (ERBP) NDT Plus, June 1, 2009; 2(3): 213 - 221. [Full Text] [PDF]
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