SP087HCV INFECTION IN NEPHROLOGY: SCREENING AND MANAGEMENT IN NEPHROPATHIC OUTPATIENTS. A 36 MONTHS EXPERIENCE

Abstract

INTRODUCTION: HCV is a risk factor for CKD and ESRD beyond traditional risk factors such as diabetes, hypertension, obesity and dyslipidemia. Furthermore the risk of developing proteinuria and CKD appears to be time dependent. Cumulative mortality is also increased. The KDIGO 2018 Hepatitis C Guidelines recommend that all patients (pts) be evaluated for renal disease when HCV is diagnosed and to screen for HCV all pts who have come to CKD observation because the prevalence of HCV may be higher in pts with CKD than in the general population. The prevalence of HCV in the world population is about of 1%, with 71 million infected subjects, and about 400.000 people die each year from causes related to HCV. However, as of 2017, only 20% of infected pts have been diagnosed and, currently, only 2% of them are annually treated. Among western countries, Italy show the highest prevalence of HCV specially in southern of Italy, mostly between the 6th and 8th decade of life, and varies between 2.6% and 6.5% of population. Effective screening is therefore necessary in order to establish early treatment. Aims of the study is run a screening and a management program of HCV in nephropathic outpatients. METHOD(S): 2798 outpatients were examined from 15 June 2017 to 15 December 2018, 108 of them were HCV positive (64 F/44 M) with a prevalence of 3.85%, mostly between the 5th and the 9th decade,and a mean age of 75.7 years. RESULT(S): The HCV-RNA test was positive in 78 of the 108 patients (72.2%); the prevalent genotypes were 1a-1b (73%) the remaining genotypes was 2 and 4. 51 patients, in collaboration for hepatologist, were underwent to Maviret (16 pts), Viekirax-Exviera (5 pts) and Sofosbuvir-based (30 pts) treatment. The mean GFR per treatment regimen was respectively 31, 40 and 51 ml/m'. 34 pts completed the therapy with a 100% of SVR 12. In these pts was observed a reduction in proteinuria from 1.18 to 0.79 g/24h (p=0.015) and an increase in GFR from 40.5 to 45 ml/m'(p=0.01). In 2017, Italian Drug Agency (AIFA) communicated 11 new treatment criteria in the context of the Italy HCV eradication plan. Criteria 3, 6, 10 and 11 are of particular interest for the nephrologist. They concern respectively on renal insufficiency, solid organ transplantation, hemodialysis and waiting list for transplantation. However data published by AIFA on dec 2018 show an unexpectedly low number of treatments initiated for nephrological criteria, compared to the treatments make for hepatological criteria, in the dates considered by our study. Prior to the availability of DAAs, treat patients with CKD, or dialysis, was a challenge as the efficacy of the IFN/ribavirin regimens was suboptimal and at risk for the toxicity. The new DAAs can be used safely in kidney disease, or dialysis, and their use is encouraged from all the guidelines. Cure of HCV is associated with improvement of the extrahepatic complications but most of the Italian regions do not have diagnostic or treatment pathways (PDTA) that include all the patients to be treated; also greater attention must be paid to the nephropathic patients, as in our case. CONCLUSION(S): Treatment of HCV-infected CKD pts lags far behind that of the general HCV population.WHOtarget for HCV elimination by 2030 requires making nephrologists more aware. Our experience can be an example to increase interest in outpatients with HCV. So, with new DAAs, the nephrologists they might treat their patients after appropriate PDTA.