Chronic Hepatitis C Virus Infection in Chronic Kidney Disease

Abstract

Chronic hepatitis C virus (HCV) infection in chronic kidney disease (CKD) patients can accelerate the decline of kidney function, increase the risk of kidney failure, and increase mortality in CKD patients on hemodialysis (HD). Chronic HCV infection is also a risk factor for mortality in kidney transplant patients. Effective detection, evaluation, and treatment for HCV infection can improve kidney and cardiovascular outcomes. In the subsequent 10 years, direct-acting antivirals (DAAs) have become available. DAAs enabled a greater rate of HCV eradication in CKD populations. Patients with stage 1-3b CKD (G1-G3b) can be treated with any licensed DAA regimens. The recommended DAA treatment regimens for CKD stage 4–5, including those undergoing HD (G4-G5D), are the sofosbuvir-free combination therapies (grazoprevir/elbasvir and glecaprevir/pibrentasvir). While sofosbuvir-based regimens are much more accessible, data showed that some countries have limited access (due to drug availability and high cost) to sofosbuvir-free regimens. Because of this phenomenon, some countries have had difficulty providing sofosbuvir-free treatment to CKD G4-G5D patients. As an alternative to those conditions, some clinicians have approved the usage of sofosbuvir-based regimens in CKD G4-G5D, but this decision is still debatable. Kidney Disease: Improving Global Outcomes (KDIGO) 2018 did not approve sofosbuvir-based regimens for CKD G4-G5D. On the contrary, other studies and guidelines have approved sofosbuvir-based regimens for CKD G4-G5D patients.