Hepatitis C virus infection and chronic kidney disease: Time for reappraisal

• Published in: Journal of hepatology Vol. 65; no. 1; pp. S82 - S94
• Main Authors: Cacoub, Patrice, Desbois, Anne Claire, Isnard-Bagnis, Corinne, Rocatello, Dario, Ferri, Clodoveo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.10.2016; Elsevier
• Subjects: Antiviral Agents - therapeutic use; Cryoglobulinemia - complications; Direct acting antiviral agents (DAA); Gastroenterology and Hepatology; Glomerulonephritis; Hepatitis C virus (HCV); Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Human health and pathology; Humans; Infectious diseases; Kidney disease; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - physiopathology; Kidney transplant; Kidney Transplantation; Life Sciences; Prevalence; Prognosis; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - physiopathology; Renal Insufficiency, Chronic - surgery; Risk Factors; Treatment; Urology and Nephrology; DAAs; Kidney disease; Glomerulonephritis; Treatment; Kidney transplant; Direct acting antiviral agents (DAA); HCV; Hepatitis C virus (HCV); SVR; hepatitis C virus; sustained viral response; direct acting antiviral agents; direct acting antiviral agents (DAA); kidney transplant; treatment; kidney disease; glomerulonephritis
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2016.06.011

Hepatitis C virus (HCV) infection is associated with tremendous morbidity and mortality due to liver complications. HCV infection is also associated with many extrahepatic manifestations including cardiovascular diseases, glucose metabolism impairment, cryoglobulinemia vasculitis, B cell non-Hodgkin lymphoma and chronic kidney disease (CKD). Many studies have shown a strong association between HCV and CKD, by reporting (i) an increased prevalence of HCV infection in patients on haemodialysis, (ii) an increased incidence of CKD and proteinuria in HCV-infected patients, and (iii) the development of membranoproliferative glomerulonephritis secondary to HCV-induced cryoglobulinemia vasculitis. HCV seropositivity is found to be associated with an increased relative risk for all-cause and cardiovascular mortality in the dialysis population. HCV seropositivity is linked to lower patient and graft survival after kidney transplantation. Such poor HCV-associated prognosis should have encouraged clinicians to treat HCV in CKD patients. However, due to frequent side effects and the poor efficacy of interferon-based treatments, very few HCV dialysis patients have received HCV medications until now. The emergence of new direct acting, interferon-free antiviral treatment, leading to HCV cure in most cases with a satisfactory safety profile, will shortly modify the management of HCV infection in CKD patients. In patients with a glomerular filtration rate (GFR) >30ml/min, the choice of DAA is not restricted. In those with a GFR <30 and >15ml/min, only paritaprevir/ritonavir/ombitasvir/dasabuvir or a grazoprevir plus elbasvir regimen are approved. In patients with end stage renal disease (GFR <15ml/min or dialysis), current data only allows for the use of a grazoprevir plus elbasvir combination. No doubt these data will be modified in the future with the advent of new studies including larger cohorts of HCV patients with renal impairment.