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

Table 2 Direct acting antiviral agent options for patients with kidney disease

HCV/kidney disease consideration	Complications and observations from HCV infection	DAA options	Other DAA options/notes
HCV related acute glomerulonephritis with or without cryoglobulinemia	HCV has tropism for B-cells with subsequent: Mixed cryoglobulinemia	Sofosbuvir 400 mg/d combined with	Can use: Grazoprevir 100 mg/elbasvir 50 mg/d
		Simeprivir 150 mg/d
		Daclastavir 60 mg/d	Ombitasvir 12.5 mg/paritaprevir 75 mg/ritonavir 50 mg × 2 tabs/dasabuvir 250 mg × 2 tabs
	Glomerulonephritis with distinct histological patterns: Membranous nephropathy	Velpatasvir 100 mg/d
		Ledipasvir 90 mg/d
	Membranoproliferative GN
The HCV-infected patient with stage 1-3a chronic kidney disease (GFR > 45 mL/min)	Increased risk for CKD development	Sofosbuvir 400 mg/d combined with	Can use
	Increased rate of CKD progression to ESRD	Simeprivir 150 mg/d	Grazoprevir 100 mg/elbasvir 50 mg/d
		Daclastavir 60 mg/d
	Higher mortality rate	Velpatasvir 100 mg/d	Ombitasvir 12.5 mg/paritaprevir 75 mg/ritonavir 50 mg × 2 tabs/dasabuvir 250 mg × 2 tabs
		Ledipasvir 90 mg/d
The patient with advanced stage 3 and stage 4/5 chronic kidney disease (GFR < 45 mL/min)	Receiving an anti-HCV positive allograft decreases waiting times for a deceased donor kidney	Sofosbuvir 400 mg/d combined with	Sofosbuvir not recommended with GFR < 30 mL/min
		Simeprivir 150 mg/d
		Daclastavir 60 mg/d	Can use
		Velpatasvir 100 mg/d	Grazoprevir 100 mg/Elbasvir 50 mg/d
		Ledipasvir 90 mg/d
			Ombitasvir 12.5 mg/Paritaprevir 75 mg/ritonavir 50 mg × 2 tabs/dasabuvir 250 mg × 2 tabs
The ESRD patient on dialysis	Increased risk of mortality and poor clinical outcomes in ESRD patients Increased cardiovascular risk	Grazoprevir 100 mg/Elbasvir 50 mg/d	Grazoprevir/elbasvir, ombitasvir/paritaprevir/ritonavir/dasabuvir, Dialysis population studied
		Ombitasvir 12.5 mg/Paritaprevir 75 mg/ritonavir 50 mg × 2 tabs/dasabuvir 250 mg × 2 tabs
			Minimal adverse events in patients with advanced CKD and ESRD on hemodialysis
The kidney transplant recipient with eGFR > 30 mL/min	DAA use after kidney transplant is safe and well tolerated with SVR > 97%	Sofosbuvir 400 mg/d combined with	Can use
		Simeprivir 150 mg/d	Grazoprevir 100 mg/elbasvir 50 mg/d (caution with cyclosporin)
		Daclastavir 60 mg/d
		Velpatasvir 100 mg/d	Ombitasvir 12.5 mg/paritaprevir 75 mg/ritonavir 50 mg × 2 tabs/dasabuvir 250 mg × 2 tabs
		Ledipasvir 90 mg/d

DAA: Direct-acting antiviral agent; GFR: Glomerular filtration rate; CKD: Chronic kidney disease; ESRD: End stage renal disease; HCV: Hepatitis C virus; DAA: Direct-acting antiviral; SVR: Sustained viral response.