An international survey of the diagnosis, management, and treatment of hepatitis C in patients with end-stage renal disease

Objectives: Hepatitis C is one of the leading causes of death from liver disease in the United States, and is frequently associated with renal disease. Two major organizations - the American Association for the Study of Liver Disease and the National Kidney Foundation - have published recommendations regarding the treatment of hepatitis C in the presence of chronic kidney disease; however, these guidelines do not always provide the same recommendations. Given the paucity of data on adherence to the current guidelines, a survey was conducted to provide information about the current practices of physicians in comparison to the published guidelines. Materials and Methods: An observational studywas conducted via a global survey asking physicians treating patientswho had concurrent hepatitis C and chronic kidney disease. Results: The 218 questionnaires collected requested the physician's subspecialty, the number of transplants performed at the hospital, the usual method of screening for hepatitis C, the preferred route, the indication and frequency of liver biopsy, the use of ribavirin and interferon, the use of hepatitis-C-positive donors in kidney transplant, and consent requirements. Conclusions: Our results showed that many physicians do not follow current recommendations. We argue that a consensus group be formed to set forth guidelines for themanagement of hepatitis C to optimize outcomes, and improve overall morbidity.