Progress in hepatitis C virus management in chronic kidney disease

Area of Science:

• Nephrology
• Hepatology
• Transplantation

Background:

• Hepatitis C virus (HCV) infection poses challenges in patients with chronic kidney disease (CKD).
• Limited treatment options historically existed for HCV in advanced CKD stages and post-transplant.

Purpose of the Study:

• To review the efficacy and safety of direct-acting antiviral (DAA) agents for HCV in CKD stages G4-5, end-stage renal disease, and kidney transplant recipients.
• To explore DAA use in facilitating transplantation of kidneys from HCV-infected donors and managing HCV-related cryoglobulinemia.

Main Methods:

• Systematic review of studies on DAA treatment for HCV in CKD populations.
• Analysis of outcomes including sustained virological response (SVR) rates.
• Evaluation of DAA safety in kidney transplant recipients and innovative donor strategies.

Main Results:

• DAA treatment achieves 90-100% SVR rates in all studied CKD populations, comparable to the general population.
• DAA therapy is safe and effective for kidney transplantation, including using HCV-viremic donor kidneys for uninfected recipients.
• Successful treatment of previously under-treated CKD populations with high SVR rates.

Conclusions:

• DAA agents represent a significant advancement in managing HCV in patients with advanced CKD and those undergoing kidney transplantation.
• High SVR rates with DAAs support their use in this vulnerable population and enable novel transplantation approaches.
• DAA therapy improves outcomes for HCV-infected CKD patients and facilitates organ utilization.