Published online Nov 18, 2016. doi: 10.4254/wjh.v8.i32.1343
Peer-review started: March 26, 2016
First decision: May 23, 2016
Revised: July 27, 2016
Accepted: September 13, 2016
Article in press: September 18, 2016
Published online: November 18, 2016
Hepatitis C virus (HCV) mainly targets the liver but can also induce extrahepatic manifestations. The kidney may be impacted via an immune mediated mechanism or a cytopathic effect. HCV patients are clearly at a greater risk of chronic kidney disease (CKD) than uninfected patients are, and the presence of CKD increases mortality. Interferon-based therapies and ribavirin are difficult to manage and are poorly effective in end-stage renal disease and hemodialysis. These patients should be given priority treatment with new direct anti-viral agents (DAAs) while avoiding peginterferon and ribavirin. The first results were convincing. To aid in the correct use of these drugs in patients with renal insufficiency, their pharmacokinetic properties and potential renal toxicity must be known. The renal toxicity of these new drugs was not a safety signal in clinical trials, and the drugs are generally efficient in these frail populations. These drugs are usually well tolerated, but recent cohort studies have demonstrated that these new regimens may be associated with renal side effects, especially when using sofosbuvir combinations. HCV, renal diseases and comorbidities are intimately linked. The close monitoring of renal function is required, particularly for at-risk patients (transplanted, HIV-coinfected, CKD, hypertensive or diabetic patients). New DAA regimens, which will soon be approved, will probably change the landscape.
Core tip: Hepatitis C patients are clearly at risk of chronic kidney disease (CKD). New direct anti-viral agents (DAAs) with different pharmacokinetic properties are generally efficient in such populations. However, renal toxicity has been described in frail patients such as patients with CKD, transplants and human immunodeficiency virus co-infections under real-life conditions, especially with sofosbuvir combinations. New DAAs, which will be soon approved, will probably change the landscape favorably. Close monitoring of renal function is required for at-risk patients, but patients without comorbidities are probably at a very low risk of renal toxicity.