Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2015; 7(2): 213-225
Published online Feb 27, 2015. doi: 10.4254/wjh.v7.i2.213
Management of patients with hepatitis C infection and renal disease
Chalermrat Bunchorntavakul, Monthira Maneerattanaporn, Disaya Chavalitdhamrong
Chalermrat Bunchorntavakul, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok 10400, Thailand
Monthira Maneerattanaporn, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok 10700, Thailand
Disaya Chavalitdhamrong, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Florida, Gainesville, FL 32610, United States
Author contributions: Bunchorntavakul C conceptualized, searched and reviewed literature, created the figures, drafted and reviewed the paper; Maneerattanaporn M conceptualized the paper and drafted the HCV-related renal disease part; Chavalitdhamrong D conceptualized and critically reviewed the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chalermrat Bunchorntavakul, MD, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Rajavithi Road, Ratchathewi, Bangkok 10400, Thailand. dr.chalermrat@gmail.com
Telephone: +66-2-3548081 Fax: +66-2-3548179
Received: August 15, 2014
Peer-review started: August 17, 2014
First decision: October 14, 2015
Revised: November 10, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 27, 2015
Processing time: 181 Days and 11.2 Hours
Abstract

Hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is associated with more rapid liver disease progression and reduced renal graft and patients’ survival following kidney transplantation. Evaluations and management of HCV in patients with renal disease are challenging. The pharmacokinetics of interferons (IFN), ribavirin (RBV) and some direct acting antiviral (DAA), such as sofosbuvir, are altered in patients with ESRD. With dose adjustment and careful monitoring, treatment of HCV in patients with ESRD can be associated with sustained virological response (SVR) rates nearly comparable to that of patients with normal renal function. DAA-based regimens, especially the IFN-free and RBV-free regimens, are theoretically preferred for patients with ESRD and KT in order to increase SVR rates and to reduce treatment side effects. However, based on the data for pharmacokinetics, dosing safety and efficacy of DAA for patients with severe renal impairment are lacking. This review will be focused on the evaluations, available pharmacologic data, and management of HCV in patients with severe renal impairment, patients who underwent KT, and those who suffered from HCV-related renal disease, according to the available treatment options, including DAA.

Keywords: Hepatitis C; Renal disease; Chronic kidney disease; Dialysis; Interferon; Direct acting antivirals; Cryoglobulinemia

Core tip: Hepatitis C virus (HCV) infection in patients with end-stage renal disease (ESRD) is associated with more rapid liver disease progression and reduced graft and patients’ survival following kidney transplantation. The pharmacokinetics of interferons (IFN), ribavirin (RBV) and sofosbuvir are altered in patients with ESRD. With dose adjustment and careful monitoring, treatment of HCV can be safely utilized and successful in most patients with ESRD. direct acting antiviral (DAA)-based regimens, especially IFN-/RBV-free regimens, are preferred for patients with ESRD and kidney transplantation (KT). However, due to inadequate data on clinical safety and efficacy, DAA-based therapies are not currently recommended in patients with severe renal disease. This review will be focused on evaluations and management of HCV in ESRD, KT recipients and HCV-related renal disease, according to the available treatment options including DAA.