Hepatitis C Virus Infection in Chronic Kidney Disease

Abstract

Soon after the hepatitis C virus (HCV) was identified in 1989, it was recognized that the prevalence of infection in patients with ESRD far exceeded that in the general population. Infection with HCV predisposes to the hepatic complications of cirrhosis and hepatocellular carcinoma. However, important extrahepatic manifestations include immune complex glomerular disease, accelerated progression of CKD, increases in cardiovascular event risk, and lymphoproliferative disorders. Advances in understanding the molecular biology of HCV have ushered in a new era in the treatment of this infection. Second generation direct-acting antiviral agents have revolutionized therapy, with sustained virologic response rates (undetectable viral load 12 weeks after completing therapy) of .90% in most patients. Studies using direct-acting antivirals in patients with CKD and those on dialysis are showing excellent safety and efficacy as well. In this context, it is imperative that nephrologists become familiar with this literature, reviewed here, so that the important decisions, including which patients should be treated and the optimal timing to initiate therapy, are vetted in association with the compounding issues of CKD, ESRD, and kidney transplantation.

Risk of Chronic Kidney Disease after Early and Late Helicobacter Pylori Eradication in Patients with Peptic Ulcer Disease: A Population-Based Cohort Study in Taiwan

“…Numerous previously reported infectious agents were attributed to the risk of subsequent CKD events [14]. Another possible mechanism for the pathogenesis of CKD is the relationship between chronic H. pylori infection and glucose metabolism.…”

Hepatitis C Virus Infection in ESKD Patients

“…In this context, we initiated DAA therapy with ledipasvir/sofosbuvir (Harvoni) for 12 weeks and achieved SVR12. In our experience, tacrolimus levels must be carefully monitored after beginning DAA therapy because many patients will require dosing adjustments to maintain therapeutic levels (4,10). In fact, this patient needed an approximate 25% increase in his tacrolimus dose.…”

“…The direct acting antiviral (DAA) agents deliver sustained virologic response rates (undetectable viral load 12 weeks after completion of treatment; SVR12) that routinely exceed 90% after an 8-or 12-week course of therapy. After publication of the pivotal studies completed in the general population (1,4), trials that focused on patients with CKD and ESKD infected with HCV reproduced these excellent results with low adverse event profiles (5)(6)(7)(8). With the availability of safe and effective treatment options for patients with kidney disease, it is important that nephrologists be familiar with the therapeutic possibilities best suited for those with ESKD infected with HCV.…”

Hepatitis C Virus and Kidney Disease: Evidence, Hope, and Hurdles

“…It is also removed by hemodialysis, which could lead to insufficient therapeutic concentration. These features require the appropriate protocols for drug dosage and probably plasma drug monitoring [21] , although the evidence regarding small groups of CKD patients suggests good tolerability and HCV eradication [9,21,22] . There could also be interactions between immunosuppressive drugs and DAAs [22] .…”

“…These features require the appropriate protocols for drug dosage and probably plasma drug monitoring [21] , although the evidence regarding small groups of CKD patients suggests good tolerability and HCV eradication [9,21,22] . There could also be interactions between immunosuppressive drugs and DAAs [22] . Currently, ongoing phase 2 or phase 3 clinical trials that include patients with kidney impairment [9] , and the results of longitudinal observational surveys [10] , should provide further evidence regarding the safety and efficacy of anti-HCV therapy.…”