Opportunities for treatment of the hepatitis C virus-infected patient with chronic kidney disease

Table 1 Direct acting antiviral agents: Dose and use in chronic kidney disease IV, V, end stage renal disease and kidney transplant patients

Medication dose	Use in CKD stage IV, V and ESRD	Use in kidney transplant patients - interactions with Immunosuppressant
Sofosbuvir/Simeprivir	CKD IV - GFR 15-29 mL/min: Not recommended	Decrease in TAC levels with Simeprivir
400 mg daily/150 mg daily	CKD V - GFR < 15 mL/min: Not recommended	Increase levels of both CyA and Simeprivir
	ESRD (dialysis): Not recommended	Increase or decrease levels of SRL with Simeprivir
		No changes in TAC, CyA and SRL with Sofosbuvir
Sofosbuvir/Velpatasvir	CKD IV - GFR 15-29 mL/min: Not recommended	Increase in TAC levels with Velpatasvir
400 mg/100 mg daily	CKD V - GFR < 15 mL/min: Not recommended	No changes in CyA levels with Velpatasvir
	ESRD (dialysis): Not recommended	Increase in SRL levels with Velpatasvir
		No changes in TAC, CyA and SRL with Sofosbuvir
Sofosbuvir/Daclastavir	CKD IV - GFR 15-29 mL/min: Not recommended	No changes in TAC levels with Daclastavir
400 mg daily/60 mg daily	CKD V - GFR < 15 mL/min: Not recommended	No changes in CyA levels with Daclastavir
	ESRD (dialysis): Not recommended	Increase in SRL levels with Daclastavir
		No changes in TAC, CyA and SRL with Sofosbuvir
Sofosbuvir/Ledipasvir	CKD IV - GFR 15-29 mL/min: Not recommended	No changes in TAC levels with Ledipasvir
400 mg/90 mg daily	CKD V - GFR < 15 mL/min: Not recommended	No changes in CyA levels with Ledipasvir
	ESRD (dialysis): Not recommended	No changes in SRL levels with Ledipasvir
		No changes in TAC, CyA and SRL with Sofosbuvir
Ombitasvir/Paritaprevir/ritonavir/Dasabuvir	CKD IV - GFR 15-29 mL/min: Dose adjustment not required	Increase in TAC levels (ritonavir)
12.5 mg/75 mg/50 mg × 2 tabs/250 mg × 2 tabs	CKD V - GFR < 15 mL/min: Dose adjustment not required	Increase in CyA levels (ritonavir)
	ESRD (dialysis): Dose adjustment not required. Dialysis population studied. Minimal adverse events in patients with advanced CKD and ESRD on hemodialysis	Increase in SRL levels (ritonavir)
		No changes in TAC, CyA and SRL with Ombitasvir/Paritaprevir/Dasabuvir
Grazoprevir/Elbasvir	CKD IV - GFR 15-29 mL/min: Dose adjustment not required	Increase in TAC levels with Grazoprevir
100 mg/50 mg daily	CKD V - GFR < 15 mL/min: Dose adjustment not required	Use of both CyA and Grazoprevir increase levels of
	ESRD (dialysis): Dose adjustment not required. Dialysis population studied. Minimal adverse events in patients with advanced CKD and ESRD on hemodialysis	Grazoprevir, contraindicated to use together
		Increase in SRL levels with Grazoprevir

GFR: Glomerular filtration rate; CKD: Chronic kidney disease; ESRD: End stage renal disease; TAC: Tacrolimus; CyA: Cyclosporine; SRL: Sirolimus.