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Hepatitis C virus and the kidney
Stanislas Pol1, Lucia Parlati2, Michel Jadoul3
1Université Paris Descartes; Hepatology Department, Cochin Hospital, APHP; INSERM U1223, UMS-20 and Center for Translational Science, Institut Pasteur, Paris, France. stanislas.pol@aphp.fr.
Insights
Treating Hepatitis C virus (HCV) infection in patients with chronic kidney disease (CKD) using direct-acting antivirals (DAAs) can achieve sustained virologic response (SVR). This highlights the importance of HCV treatment for improved outcomes in dialysis and transplant patients.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Hepatitis C virus (HCV) infection poses greater risks for dialysis patients and kidney transplant recipients, increasing mortality and complications like allograft/liver failure, diabetes, and cardiovascular issues.
- HCV infection exacerbates chronic kidney disease (CKD) progression and systemic complications, underscoring the need for effective treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and necessity of treating HCV in patients with CKD and kidney transplant recipients.
- To emphasize the benefits of achieving sustained virologic response (SVR) in mitigating HCV-related complications.
Main Methods:
- Review of current evidence and international guidelines on direct-acting antiviral (DAA) therapy for HCV in CKD patients.
- Analysis of SVR rates in late-stage CKD and kidney transplant recipients.
- Consideration of treatment timing and specific patient prioritization.
Main Results:
- Sustained virologic response (SVR) is achievable in over 95% of patients with late-stage CKD and kidney transplant recipients.
- Direct-acting antiviral (DAA) treatment is recommended for all CKD patients with HCV, particularly those with symptomatic cryoglobulinemic vasculitis, advanced liver fibrosis, or stage 4-5 CKD.
- DAA treatment can be safely administered before or after kidney transplantation, with potential benefits for reducing waiting times.
Conclusions:
- Eliminating HCV in CKD patients is feasible with DAA therapy, leading to attenuated disease complications.
- Reinforced hygienic measures in dialysis units are crucial to prevent HCV reinfection post-treatment.
- Ongoing evaluation of the long-term renal safety of DAAs is necessary.
Abstract:
Hepatitis C virus (HCV) infection is more prevalent and is associated with higher mortality in patients receiving dialysis and in kidney transplant recipients than in the general population. Kidney transplant recipients who are HCV-positive are also at higher risk of allograft and liver failure than are HCV-negative recipients. Moreover, HCV infection is associated with a higher incidence and faster progression of diabetes mellitus and chronic kidney disease (CKD), as well as a higher incidence of systemic (especially cardiovascular) complications. The finding that these complications of HCV infection are attenuated in patients who achieve a sustained virologic response (SVR) emphasizes the need to treat patients with CKD who are HCV-positive with oral antiviral therapies. Fortunately, the available evidence suggests that a SVR can be achieved in >95% of patients with late-stage CKD and in kidney transplant recipients. According to international guidelines, all patients with CKD and HCV infection should be considered for treatment with direct acting antivirals (DAAs), prioritizing those with symptomatic cryoglobulinaemic vasculitis, extensive liver fibrosis and stage 4-5 CKD. DAA treatment can be delayed until after transplantation in recipients whose waiting time is markedly reduced by accepting an HCV-positive organ. An emerging issue is the long-term renal safety of DAAs, which requires a re-appraisal. Overall, the elimination of HCV from patients with CKD now seems to be achievable, provided that DAA treatment is coupled with reinforced hygienic precautions to prevent reinfections in dialysis units.
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