Treating Hepatitis C in Patients with Renal Failure

There is a strong relationship between hepatitis C virus (HCV) infection and the kidney. Approximately 10-16% of the patients with HCV infection develop renal disease, and the prevalence of HCV infection in patients with renal dysfunction is higher than that of the general population (9.5 vs. 1.6%). Moreover, HCV-positive patients on hemodialysis (HD) have higher mortality rates as compared to HCV-negative patients also on HD, not only due to liver-related complications but also owing to cardiovascular disease. Key Messages: In the interferon era, the treatment of HCV infection in patients on HD was hampered due to a significant number of treatment-related adverse events (predominately anemia and infectious complications). The development of direct-acting antivirals (DAAs) has revolutionized the field allowing viral eradication in these very sick patients. Two recently published clinical trials assessed the efficacy and safety of DAAs in patients with end-stage renal disease (ESRD). The combination of grazoprevir and elbasvir has been studied in the C-SURFER trial with 94% of the patients achieving sustained virological response (SVR). Adverse events were mild and only a small number of patients discontinued therapy early due to adverse events. The 3D regimen was evaluated in the RUBY-I trial. Here, a 90% SVR rate was achieved in 20 patients with ESRD, most of them on HD. Although sofosbuvir is eliminated by the kidney and its use in patients with glomerular filtration rate <30 mL/min is not recommended, real-life data have shown good results for this drug in terms of efficacy and safety.

The use of DAAs has safely permitted the treatment of patients with renal dysfunction with excellent efficacy results.