APASL clinical practice recommendation: how to treat HCV-infected patients with renal impairment?

Tatsuo Kanda, George K.K. Lau, Lai Wei, Mitsuhiko Moriyama, Ming Lung Yu, Wang Long Chuang, Alaaeldin Ibrahim, Cosmas Rinaldi Adithya Lesmana, Jose Sollano, Manoj Kumar, Ankur Jindal, Barjesh Chander Sharma, Saeed S. Hamid, A. Kadir Dokmeci, Mamun-Al-Mahtab, Geofferey W. McCaughan, Jafri Wasim, Darrell H.G. Crawford, Jia Horng Kao, Osamu YokosukaShiv Kumar Sarin, Masao Omata

Research output: Contribution to journalArticlepeer-review

32 Citations (Scopus)


Chronic hepatitis C virus (HCV) infection is common among patients with chronic kidney disease (CKD) and those on hemodialysis due to nosocomial infections and past blood transfusions. While a majority of HCV-infected patients with end-stage renal disease are asymptomatic, some may ultimately experience decompensated liver diseases and hepatocellular carcinoma. Administration of a combination of elbasvir/grazoprevir for 12 weeks leads to high sustained virologic response (SVR) rates in patients with HCV genotypes (GTs) 1a, 1b or 4 and stage 4 or 5 CKD. Furthermore, a combination of glecaprevir/pibrentasvir for 8–16 weeks also results in high SVR rates in patients with all HCV GTs and stage 4 or 5 CKD. However, these regimens are contraindicated in the presence of advanced decompensated cirrhosis. Although sofosbuvir and/or ribavirin are not generally recommended for HCV-infected patients with severe renal impairment, sofosbuvir-based regimens may be appropriate for those with mild renal impairment. To eliminate HCV worldwide, HCV-infected patients with renal impairment should be treated with interferon-free therapies.

Original languageEnglish
Pages (from-to)103-109
Number of pages7
JournalHepatology International
Issue number2
Publication statusPublished - 12 Mar 2019


  • DAA
  • Guideline
  • HCV
  • Hemodialysis
  • Renal impairment
  • SVR


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