Michel Jadoul

Michel Jadoul is a Brussels-based nephrologist, co-editor of the volume, and a contributing author on hepatitis C in hemodialysis. His place in the book is defined less by a personal biography than by a sustained clinical and epidemiological project: explaining how hepatitis C moved from a largely recognized danger among dialysis patients to a more precisely diagnosed, monitored, and preventable infection, while showing why the problem remains consequential for patients with chronic kidney disease.

Identity and Editorial Role

Michel Jadoul is listed among the volume’s co-editors, alongside Beatriz Domínguez-Gil, Josep M. Campistol, Lionel Rostaing, and David Roth. The editorial network is geographically broad, linking Brussels with Madrid, Barcelona, Toulouse, and Miami, but Jadoul’s own institutional location is Brussels. He is also identified as the author of the chapter “Hepatitis C in Hemodialysis: Epidemiology and Prevention of Hepatitis C Virus Transmission,” written with Guillermina Barril. The chapter is associated with Cliniques Universitaires Saint-Luc and the Université catholique de Louvain in Brussels, while Barril is associated with Hospital Universitario de la Princesa in Madrid.

This editorial and authorship role gives Jadoul a double function in the book. He helps organize a multi-author medical account, yet his chapter also supplies one of its clearest historical frameworks: the epidemiology of hepatitis C among patients receiving hemodialysis and the practical measures required to prevent transmission. His contribution therefore joins the book’s broad concerns about viral disease, renal failure, transplantation, and clinical governance to the specific environment of the dialysis unit.

Epidemiological Focus

Jadoul’s chapter presents the history of hepatitis C in hemodialysis as a story of changing medical knowledge. The identification of hepatitis C as the principal cause of non-A, non-B hepatitis in 1989 altered the interpretation of earlier outbreaks and made it possible to examine dialysis-associated infection as a distinct epidemiological problem. When serological tests became available, patients receiving hemodialysis were unsurprisingly recognized as a high-risk group. Their risk was partly connected with the frequent blood transfusions used at the time, and therefore with post-transfusional hepatitis C.

Jadoul’s analysis does not, however, reduce the high prevalence in dialysis patients to transfusion alone. Several observations supported continuing nosocomial transmission within hemodialysis units: infection prevalence correlated strongly with time on dialysis in some studies even after accounting for transfusion exposure; prevalence was higher among patients receiving hemodialysis than among those receiving peritoneal dialysis or home hemodialysis; and substantial infection rates occurred among patients who had never been transfused. In the early 1990s, prevalence and incidence were almost uniformly high in Western countries. These contrasts make the dialysis unit itself part of the epidemiological explanation rather than merely a passive setting in which already-acquired infections are observed.

His contribution also belongs to a larger diagnostic framework developed throughout the volume. Active chronic HCV infection is distinguished from resolved infection by the presence of HCV RNA in serum, not by antibody positivity alone. Chronic infection requires both anti-HCV antibodies and detectable HCV RNA, with sensitive molecular assays operating at a threshold of approximately 15 IU/ml. For patients with active infection, evaluation must address both hepatic disease and extrahepatic manifestations such as cryoglobulinemia-associated vasculitis. Jadoul’s prevention-focused account thus rests on a broader distinction between exposure, persistent infection, and clinically consequential disease.

Prevention and Clinical Infrastructure

The preventive argument associated with Jadoul is practical and institutional. The book identifies serological screening of blood products, routine use of erythropoietin for patients with anemia and chronic kidney disease, and compliance with infection-control procedures as measures that helped reduce HCV transmission among patients on maintenance dialysis in developed countries. Yet the reduction in transmission does not make the problem historical. Dialysis patients remain vulnerable, and basic hygienic precautions remain the cornerstone of preventing nosocomial transmission.

This emphasis places responsibility on everyday clinical practice rather than on a single technological intervention. The dialysis unit is a repeated-contact environment in which equipment, procedures, staff practices, and patient turnover can shape infection risk. Prevention therefore depends on consistent application of universal precautions and infection-control procedures. Jadoul’s chapter reviews available strategies for preventing transmission to hemodialysis patients, while the wider volume connects those strategies to KDIGO guidance on hepatitis C in chronic kidney disease.

The importance of this infrastructure becomes clearer when set beside the volume’s account of diagnosis and surveillance. Third-generation ELISA assays detect anti-HCV antibodies, but only molecular detection of serum HCV RNA establishes active infection. In kidney-transplant candidates, screening must likewise be adapted to local prevalence: enzyme immunoassay followed by nucleic acid testing in lower-prevalence regions, and nucleic acid testing as the initial test in higher-prevalence settings because a negative antibody test cannot reliably exclude infection. Jadoul’s subject is therefore not simply the virus, but the chain of testing, interpretation, hygiene, and follow-up through which a medical system manages it.

Disease Burden in Dialysis Patients

The clinical context surrounding Jadoul’s work is severe even when infection is clinically quiet. HCV-related liver disease is often asymptomatic in patients receiving long-term dialysis. Fatigue, asthenia, and cognitive impairment may be difficult to attribute because they are also common in the dialysis population regardless of HCV status. Biochemical abnormalities can likewise be overlooked amid multiple comorbidities, including hypertension, gastrointestinal bleeding, anemia, and vascular-access failure. Cirrhosis is relatively infrequent among dialysis patients in the Western world, reported in some international registries at approximately 1.5% to 2%, but low apparent prevalence does not erase the infection’s broader consequences.

A meta-analysis of seven observational studies involving 11,589 dialysis patients reported an adjusted all-cause mortality relative risk of 1.34 for patients with anti-HCV antibodies, with a 95% confidence interval of 1.13 to 1.59. Liver-related mortality was also markedly higher: the unadjusted risk estimate was 5.89, with a 95% confidence interval of 1.93 to 17.99. Hepatocellular carcinoma and cirrhosis were more frequent causes of death among anti-HCV-positive than among seronegative dialysis patients. The evidence therefore gives Jadoul’s prevention agenda a clear stake in survival, not merely in laboratory classification.

The book also links HCV infection to quality of life and possibly to cardiovascular risk. In a study of 165 patients receiving regular dialysis, 83 of whom were anti-HCV positive, anti-HCV status was independently associated with a lower mental component score on the SF-36 quality-of-life assessment, although no association with the physical component score was found. Depression, concerns about long-term health, fatigue, cognitive impairment, and the burdens of hemodialysis may reinforce one another. Other observations associate HCV viremia with increased aortic stiffness: among 94 dialysis patients, HCV viremia was independently associated with high pulse-wave velocity, with an odds ratio of 9.7, although a separate meta-analysis did not find a significant unadjusted relative risk for cardiovascular mortality. The contrast illustrates the cautious, evidence-sensitive character of the field Jadoul represents.

Relation to Transplantation and Treatment

Jadoul’s dialysis-centered contribution also leads toward transplantation. HCV infection affects the evaluation of kidney-transplant candidates because 10% to 25% may have advanced liver injury, including stage 3 or 4 fibrosis or cirrhosis, when assessed by liver biopsy. Active infection requires evaluation of hepatic and extrahepatic effects, and noninvasive tools such as FibroScan can support follow-up, although liver biopsy remains the most reliable method for determining the extent of fibrosis in transplant candidates. Patients with established or decompensated cirrhosis may need referral for consideration of simultaneous liver–kidney transplantation rather than kidney transplantation alone.

The waiting-list problem adds time to the medical narrative. In some areas, waiting for a deceased-donor kidney approaches five to seven years, so HCV-infected candidates require continuing surveillance to ensure that liver disease has not progressed and that they remain suitable for transplantation. Patients who achieve a sustained virologic response should undergo at least annual nucleic acid testing to confirm that the response persists; patients with relapse should be placed on hold and referred for possible retreatment. Among candidates who remained viremic while waiting, repeat biopsy showed interval worsening in 8 of 13 patients, or 62%, compared with worsening in 7 of 31, or 23%, of follow-up biopsies obtained after transplantation.

Treatment is correspondingly balanced against toxicity and transplant timing. Therapy may be considered at any stage of HCV infection, particularly when chronic fatigue, necroinflammation, significant fibrosis, or symptomatic cryoglobulinemia-associated vasculitis is present. Interferon-based treatment can produce flu-like symptoms, anemia, neutropenia, depression, and anxiety; dose reduction has been required in 35% to 42% of patients, and treatment discontinuation in about 30%. The wider transplant literature further shows why eradication before transplantation can matter: HCV-infected allograft recipients are prone to immune complex-mediated glomerulonephritis, including de novo membranoproliferative glomerulonephritis, with hypertension, microhematuria, proteinuria, renal dysfunction, and sometimes nephrotic syndrome. Prevention in the dialysis unit, diagnosis before transplantation, and treatment decisions after risk assessment thus form one continuous clinical sequence.

Narrative Significance

Michel Jadoul’s significance in the volume lies in connecting historical epidemiology to institutional practice. His subject begins with a population recognized as high risk and with an outbreak history partly obscured by transfusion exposure. It develops into a more differentiated account in which active infection is confirmed by HCV RNA, transmission is linked to the dialysis environment, and prevention depends on ordinary hygienic discipline applied without interruption.

At the same time, his contribution resists the idea that a quieter clinical presentation means a minor disease. HCV may be asymptomatic, biochemical abnormalities may be hidden among dialysis-related comorbidities, and cirrhosis may be uncommon, yet infection is associated with excess mortality, liver-related death, impaired mental quality of life, and possible cardiovascular injury. Jadoul’s chapter consequently gives the book one of its central practical lessons: controlling transmission is not a narrow infection-control task but a way of protecting future treatment options, transplant eligibility, graft function, and survival.