Treatment of Hepatitis C Virus-Infected Patients with Renal Failure

  • Bilgul Mete
  • Fehmi Tabak


The prevalence of hepatitis C virus infection in patients with renal diseases is higher compared to the general population. On the other hand chronic HCV infection is independently associated with the development of chronic kidney disease. The selection of the most appropriate regimen depends on genotype, presence or absence of cirrhosis, prior treatment history, and, in patients with renal failure, degree of renal impairment. Since HCV infection in end-stage renal disease patients may lead to increased risk of all-cause and liver-related mortality, HCV-infected patients with renal impairment should be considered for antiviral therapy. According to the major guidelines fixed-dose combination of glecaprevir/pibrentasvir is the recommended regimen for all genotypes for 8–16 weeks. Fixed-dose combination of elbasvir/grazoprevir is recommended for genotypes 1a–b and genotype 4 for 12 weeks. Paritaprevir, ritonavir, ombitasvir, and dasabuvir with or without ribavirin are other alternatives for patients with severe renal impairment or with end-stage renal disease infected with genotype 1a or genotype 4. But in resource-limited areas where directly acting antivirals are not available pegylated interferon and ribavirin may still be the only alternatives for treatment especially in patients infected with genotypes 2 and 3.


Hepatitis C Treatment Renal failure Directly acting antivirals 


  1. 1.
    Ladino M, Pedraza F, Roth D. Hepatitis C virus infection in chronic kidney diseases. J Am Soc Nephrol. 2016;27:2238–46.CrossRefGoogle Scholar
  2. 2.
    Finelli L, Miller JT, Tokars JI, et al. National surveillance of dialysis-associated diseases in the United States, 2002. Semin Dial. 2005;18:52.CrossRefGoogle Scholar
  3. 3.
    Fabrizi F, Verdesca S, Messa P, et al. Hepatitis C virus infection increases the risk of developing chronic kidney disease: a systematic review and meta-analysis. Dig Dis Sci. 2015;60(12):3801–13.CrossRefGoogle Scholar
  4. 4.
    Johnson RJ, Gretch DR, Couser WG, et al. Hepatitis C virus-associated glomerulonephritis. Effect of alpha-interferon therapy. Kidney Int. 1994;46:1700.CrossRefGoogle Scholar
  5. 5.
    McGuire BM, Julian BA, Bynon JS Jr, et al. Brief communication: glomerulonephritis in patients with hepatitis C cirrhosis undergoing liver transplantation. Ann Intern Med. 2006;144:735.CrossRefGoogle Scholar
  6. 6.
    Levey AS, Atkins R, Coresh J, et al. Chronic kidney disease as a global public health problem: approaches and initiatives—a position statement from kidney disease improving global outcomes. Kidney Int. 2007;72:247.CrossRefGoogle Scholar
  7. 7.
    Dumortier J, Bailly F, Pageaux GP, et al. Sofosbuvir-based antiviral therapy in hepatitis C virus patients with severe renal failure. Nephrol Dial Transplant. 2017;32:2065–71.Google Scholar
  8. 8.
  9. 9.
    European Association for the Study of the Liver. EASL recommendations on treatment of hepatitis C 2018. J Hepatol. 2018;69(2):461–511.Google Scholar
  10. 10.
    Leise MD, Rostaing L. Treatment of chronic hepatitis C infection in adults with renal impairment. UpToDate Version 19.0.Google Scholar
  11. 11.
    Liu CH, Huang CF, Liu CJ, et al. Pegylated interferon-α2a with or without low-dose ribavirin for treatment-naive patients with hepatitis C virus genotype 1 receiving hemodialysis: a randomized trial. Ann Intern Med. 2013;159:729.CrossRefGoogle Scholar
  12. 12.
    Tseng PL, Chen TC, Chien YS, et al. Efficacy and safety of pegylated interferon alfa-2b and ribavirin combination therapy versus pegylated interferon monotherapy in hemodialysis patients: a comparison of 2 sequentially treated cohorts. Am J Kidney Dis. 2013;62:789.CrossRefGoogle Scholar
  13. 13.
    Gilead. Sofosbuvir for treatment of chronic hepatitis C infection. Briefing document prepared for the Antiviral Drugs Advisory Committee Meeting, 25 Oct 2013.
  14. 14.
    Rostaing L, Chatelut E, Payen JL, et al. Pharmacokinetics of alphaIFN-2b in chronic hepatitis C virus patients undergoing chronic hemodialysis or with normal renal function: clinical implications. J Am Soc Nephrol. 1998;9:2344.PubMedGoogle Scholar
  15. 15.
    Uchihara M, Izumi N, Sakai Y, et al. Interferon therapy for chronic hepatitis C in hemodialysis patients: increased serum levels of interferon. Nephron. 1998;80:51.CrossRefGoogle Scholar
  16. 16.
    Beuthien W, Mellinghoff HU, Kempis JV. Vasculitic complications of interferon-alpha treatment for chronic hepatitis C virus infection: case report and review of the literature. Clin Rheumatol. 2005;24:507.CrossRefGoogle Scholar
  17. 17.
    Ohta S, Yokoyama H, Wada T, et al. Exacerbation of glomerulonephritis in subjects with chronic hepatitis C virus infection after interferon therapy. Am J Kidney Dis. 1999;33:1040.CrossRefGoogle Scholar
  18. 18.
    Pegylated interferon (peginterferon) alfa-2a: drug information. UpToDate Lexicomp.Google Scholar
  19. 19.
    Pegylated interferon (peginterferon) alfa-2b: drug information. UpToDate Lexicomp.Google Scholar
  20. 20.
    Kamar N, Boulestin A, Selves J, et al. Factors accelerating liver fibrosis progression in renal transplant patients receiving ribavirin monotherapy for chronic hepatitis C. J Med Virol. 2005;76:61.CrossRefGoogle Scholar
  21. 21.
    Rebetol (ribavirin). US FDA approved product information. National Library of Medicine.
  22. 22.
    Copegus (ribavirin). US FDA approved product information. National Library of Medicine.
  23. 23.
    Fabrizi F, Dixit V, Messa P, et al. Interferon monotherapy of chronic hepatitis C in dialysis patients: meta-analysis of clinical trials. J Viral Hepat. 2008;15(2):79–88.PubMedGoogle Scholar
  24. 24.
    Rendina M, Schena A, Castellaneta NM, et al. The treatment of chronic hepatitis C with peginterferon alfa-2a (40 kDa) plus ribavirin in haemodialysed patients awaiting renal transplant. J Hepatol. 2007;46(5):768–74.CrossRefGoogle Scholar
  25. 25.
    Liu CH, Kao JH. Treatment of hepatitis C virus infection in patients with end-stage renal disease. J Gastroenterol Hepatol. 2011;26(2):228–39.CrossRefGoogle Scholar
  26. 26.
    Saxena V, Koraishy FM, Sise ME, et al. HCV-TARGET. Safety and efficacy of sofosbuvir-containing regimens in hepatitis C-infected patients with impaired renal function. Liver Int. 2016;36(6):807–16.CrossRefGoogle Scholar
  27. 27.
    Aggarwal A, Yoo ER, Perumpail RB, et al. Sofosbuvir use in the setting of end-stage renal disease: a single center experience. J Clin Transl Hepatol. 2017;5:23–6.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Singh T, Guirguis J, Anthony S, et al. Sofosbuvir-based treatment is safe and effective in patients with chronic hepatitis C infection and end stage renal disease: a case series. Liver Int. 2016;36:802.CrossRefGoogle Scholar
  29. 29.
    Desnoyer A, Pospai D, Lê MP, et al. Pharmacokinetics, safety and efficacy of a full dose sofosbuvir-based regimen given daily in hemodialysis patients with chronic hepatitis C. J Hepatol. 2016;65:40.CrossRefGoogle Scholar
  30. 30.
    Omata M, Kanda T, Wei L, et al. APASL consensus statements and recommendation on treatment of hepatitis C. Hepatol Int. 2016;10(5):702–26.CrossRefGoogle Scholar
  31. 31.
    Pockros PJ, Reddy KR, Mantry PS, et al. Efficacy of direct-acting antiviral combination for patients with hepatitis C virus genotype 1 infection and severe renal impairment or end-stage renal disease. Gastroenterology. 2016;150:1590.CrossRefGoogle Scholar
  32. 32.
    Roth D, Nelson DR, Bruchfeld A, et al. Grazoprevir plus elbasvir in treatment-naive and treatment experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet. 2015;386(10003):1537–45.CrossRefGoogle Scholar
  33. 33.
  34. 34.
    Gane E, Lawitz E, Pugatch D, et al. EXPEDITION-4: efficacy and safety of glecaprevir/pibrentasvir (ABT-493/ABT-530) in patients with renal impairment and chronic hepatitis C virus genotype 1-6 infection. In: Presented at the American Association for the Study of Liver Diseases Liver Meeting, Boston, MA, 11–15 Nov 2016.Google Scholar
  35. 35.
    Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2008;8:S1.Google Scholar
  36. 36.
    Colombo M, Aghemo A, Liu H, et al. Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks in kidney transplant recipients with chronic hepatitis C virus genotype 1 or 4 infection: a randomized trial. Ann Intern Med. 2017;166(2):109–17.CrossRefGoogle Scholar
  37. 37.
    Kamar N, Marion O, Rostaing L, et al. Efficacy and safety of sofosbuvir-based antiviral therapy to treat hepatitis C virus infection after kidney transplantation. Am J Transpl. 2016;16(5):1474–9.CrossRefGoogle Scholar
  38. 38.
    Sawinski D, Kaur N, Ajeti A, et al. Successful treatment of hepatitis C in renal transplant recipients with direct-acting antiviral agents. Am J Transplant. 2016;16(5):1588–95.CrossRefGoogle Scholar
  39. 39.
    Reau N, Kwo PY, Rhee S. MAGELLAN-2: safety and efficacy of glecaprevir/pibrentasvir in liver or renal transplant adults with chronic hepatitis C genotype 1–6 infection. In: EASL International Liver Meeting, Apr 2017.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bilgul Mete
    • 1
  • Fehmi Tabak
    • 1
  1. 1.Department of Infectious Diseases and Clinical MicrobiologyCerrahpasa School of Medicine, Istanbul UniversityIstanbulTurkey

Personalised recommendations