Treating Hepatitis C Infection in Patients With Chronic Kidney Disease: Our Options Have Improved Greatly

Chronic hepatitis C infection (HCV) is a common problem in patients with kidney disease (Corouge M. et al. Liver Int (2016); 36:28–33, Fabrizi F. et al. Int. J. Artif. Organs (2017); 0). In the past, treatment of hepatitis C infection was very difficult due to poor efficacy, significant side effects, and the multiple comorbidities that affect patients with advanced kidney disease (Pockros PJ et al. Gastroenterology (2016); 150:1590–1598). Significant recent advances in oral interferon-free treatment regimens allow patients with hepatitis C to be treated effectively with minimal side effects. For patients with genotype 1a, 1b, or 4, there are several recommended oral regimens that achieve virologic cure in greater than 95% of patients, even in patients with severe or end-stage renal disease. For other genotypes, specifically 2, 3, 5, and 6, treatment with direct acting antiviral (DAA) agents that are used in patients with normal renal clearance has significant potential for side effects and is not recommended. Patients who are waiting for a kidney transplant or who have received a kidney transplant and have estimated eGFR greater than 30 ml/min can be treated with multiple regimens in an attempt to cure their hepatitis C (Fabrizi F. et al. Int. J. Artif. Organs (2017); 0). Patients with kidney-related complications due to their chronic hepatitis C infection can also be treated with a significant chance of resolution of the complication (Corouge M. et al. Liver Int (2016); 36:28–33, Kamar N. et al. Clin. Nephrol (2008); 69:149–160).