To the Editor,

Haemodialysis units’ health policies and protocols are disparate meaning that prevalence of chronic hepatitis C infection is extremely variable in the haemodialysis population.1-3 In some countries classic infection factors, such as material contaminated due to reuse or blood transfusions, have been replaced by parenteral drug addiction or sexual transmission.4,5 It is not surprising that prevention is the most adequate and cost-effective control measure for these patients.

Treating chronic HCV before kidney transplantation is currently not an essential criteria for including HCV-positive patients on the transplant waiting list. However, risk of post-transplant chronic hepatitis C and the difficulty to treat it at this stage of the chronic kidney disease have been reported.6-11

Pegylated interferon and interferon + ribavirin are better than conventional interferon, according to clinical trials. However, the differences are small. Combining ribavirin and pegylated interferon requires close follow-up during haemodialysis given the severity of the secondary effects. It has increased the sustained viral response, although it is still less in the population without chronic kidney disease.12 This, along with the difficulty of treating patients with stages 4 and 5 chronic kidney disease in predialysis, highlights the importance of resolving the infection at early kidney disease stages.

Transjugular liver biopsy reduces the risks of bleeding associated with this procedure and the kidney patient, although there is little evidence in the literature.13,14 This technique also allows the hepatic venous pressure gradient to be measured, providing diagnostic and prognostic data.

Studies that determine whether the association of protease inhibitors (telaprevir, boceprevir) with interferon and ribavirin is safe for kidney patients and may increase viral response rates.