It is a close, bidirectional relationship between hepatic C virus (HCV)
infection and chronic kidney disease (CKD). On one hand, HVC patients have an
increased risk of CKD, the most frequent form being cryoglobulin-immune-mediated
glomerulonephritis. On the other hand, CKD patients, especially those in dialysis units,
have an increased risk of HCV infection, with an increased cardiovascular and allcause mortality. Direct acting antiviral agents (DAA) has revolutionized the treatment
of HCV, including patients with CKD, dialysis, and kidney transplantation (KT).
Patients with CKD stage 1-3b can be treated with any DAA approved regimen. In
patients with CKD stages 4-5, including hemodialysis patients, there are three regimens
approved: glecaprevir/pibrentasvir, elbasvir/grazoprevir and paritaprevir/ritonavir/
ombitasvir/dasabuvir. However, more recently, there are many pieces of evidence that,
in spite of initial recommendations, Sofosvubir-based regimens can be safe and
effective in patients with end-stage CKD. Many DAA regimens demonstrated very
good results (sustained viral response – 98-100%) and very well tolerability in KT
recipients, the main concern being drug-drug interaction between DAA and
immunosuppressive therapy. One of the major challenges of the last years is the
possibility to transplant an HCV- positive kidney in an HCV-negative recipient, with
DAA treatment following transplantation, with the increase of the organ supply and the
avoidance of long term dialysis complications. With preventive measures in dialysis
units and DAA treatment in all categories of patients, the elimination of HCV infection
in CKD patients can be a realistic goal.
Keywords: Chronic kidney disease, Direct acting antiviral agents, Hemodialysis, Hepatitis C virus, Kidney transplantation, Sustained viral response
