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Treatment of chronic hepatitis C infection in adults with renal impairment

Michael D Leise, MD
Lionel Rostaing, MD, PhD
Section Editors
Adrian M Di Bisceglie, MD
Fernando C Fervenza, MD, PhD
Deputy Editor
Allyson Bloom, MD


There is a strong and likely causal association between chronic hepatitis C virus (HCV) infection and glomerular disease, including mixed cryoglobulinemia, membranoproliferative glomerulonephritis (MPGN), and possibly membranous nephropathy [1]. In addition, the prevalence of anti-HCV antibody is higher among patients on hemodialysis compared with healthy populations, suggesting that dialysis patients may be at higher risk of acquiring HCV infection. In fact, the prevalence of a positive HCV antibody test in the hemodialysis population in the United States is 5 to 10 percent [2]. Antiviral treatment in these patients can be complicated because many of the agents used for anti-HCV therapy can accumulate to toxic levels in the setting of renal impairment. Thus, patients with renal disease and chronic HCV infection represent an important population that warrants specific consideration.

It is anticipated that the management of HCV in adults with significant kidney disease (ie, estimated glomerular filtration rate <30 mL/min per 1.73 m2) will undergo substantial changes over the near future due to the availability of new direct-acting antiviral agents. New HCV medications have allowed for interferon-free, and in some cases, ribavirin-free treatment regimens in patients without renal impairment. However, these agents have to be studied in the patient populations with kidney disease before they can be adopted for widespread use in this historically difficult-to-treat population.

This topic will discuss the approach to antiviral therapy of HCV-infected patients with renal impairment. However, other management issues, such as immunosuppressive therapy as well as treatment of proteinuria and hypertension or other complications of renal disease, may be important in such patients. Discussions of renal disease associated with HCV infection, the epidemiology and prevention of HCV infection among dialysis patients, and HCV infection associated with renal transplantation are found in detail elsewhere:

(See "Overview of renal disease associated with hepatitis C virus infection".)

(See "Clinical manifestations and diagnosis of the mixed cryoglobulinemia syndrome (essential mixed cryoglobulinemia)" and "Treatment of the mixed cryoglobulinemia syndrome".)

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Literature review current through: Oct 2017. | This topic last updated: Aug 24, 2017.
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