Efficacy and safety of sofosbuvir based antiviral therapy for chronic hepatitis C infection in patients with advanced chronic kidney disease


  • Shahid Rasool Department of Gastroenterology, Madina Teaching Hospital, Faisalabad, Pakistan
  • Ahmad N. Babar Department of Gastroenterology, Madina Teaching Hospital, Faisalabad, Pakistan
  • Muhammad Wasif Baig Department of Nephrology, Madina Teaching Hospital, Faisalabad, Pakistan
  • Salman Azhar Department of Medicine, Madina Teaching Hospital, Faisalabad, Pakistan
  • Muhammad Saeed Akhtar Department of Medicine, Madina Teaching Hospital, Faisalabad, Pakistan




Chronic renal failure, Hepatitis C, Sofosbuvir


Background: Screening studies for hepatitis C have proved that it is more prevalent in patients with renal diseases. Chronic hepatitis C infection in patients with kidney disease not only accelerates renal deterioration but also adversely effects morbidity and mortality. Availability of direct acting antiviral drugs has revolutionized treatment of hepatitis C even in difficult patients. In advanced kidney diseases, selection of treatment is difficult. Aim of this study was to evaluate the efficacy and safety of Sofosbuvir based DAAs in patients with advanced CKD.

Methods: In this Quasi experimental study, CHC patients with or without cirrhosis having advance CKD (eGFR <30 ml/min per 1.73 m2) and/or on dialysis were enrolled. End points of the study were documentation of SVR 12 or discontinuation of therapy. Different regimens of oral DAAs with or without Ribavirin were used.

Results: 86 patients with a median age of 53 years were enrolled. 37 patients were on maintenance dialysis and 49 were not on dialysis with eGFR <30 ml/min per 1.73 m2. Virological response was 92.68% at the end of treatment and SVR was achieved by 90.2% twelve weeks after therapy. Insomnia 14%, headache 11% and anemia 7% were main dverse effects. Mean eGFR and creatinine before and after treatment remained the same. Only 2 patients relapsed, both were on dialysis thrice weekly.

Conclusions: All Sofosbuvir based regimens used for the treatment of CHC in patients with end stage renal disease are effective and well tolerated. Close follow up is advised to monitor side effects.

Author Biography

Salman Azhar, Department of Medicine, Madina Teaching Hospital, Faisalabad, Pakistan

Assistant Professor

Department of Medicine


Ladino M, Pedraza F, Roth D. Hepatitis C virus infection in chronic kidney disease. Journal of the Am Soc Nephrol. 2016 Aug 1;27(8):2238-46.

Thrift AP, El-Serag HB, Kanwal F. Global epidemiology and burden of HCV infection and HCV-related disease. Nat Rev Gastroenterol Hepatol. 2017 Feb;14(2):122-32.

Bunchorntavakul C, Maneerattanaporn M, Chavalitdhamrong D. Management of patients with hepatitis C infection and renal disease. World J Hepatol. 2015 Feb 27;7(2):213-25.

Umer M, Iqbal M. Hepatitis C virus prevalence and genotype distribution in Pakistan: Comprehensive review of recent data. World J Gastroenterol. 2016 Jan 28;22(4):1684-700.

Kim SM, Song IH. Hepatitis C virus infection in chronic kidney disease: paradigm shift in management. Kor J Intern Med. 2018;33(4):670-78.

Cacoub P, Gragnani L, Comarmond C, Zignego AL. Extrahepatic manifestations of chronic hepatitis C virus infection. Dig Liver Dis. 2014;46(5):S165-S73.

Cacoub P, Comarmond C, Domont F, Savey L, Desbois AC, Saadoun D. Extrahepatic manifestations of chronic hepatitis C virus infection. Ther Adv Infect Dis. 2016;3:3-14.

Fabrizi F, Verdesca S, Messa P, Martin P. Hepatitis C virus infection increases the risk of developing chronic kidney disease: a systematic review and meta-analysis. Digest Dis Scie. 2015 Dec 1;60(12):3801-13.

Morales JM, Kamar N, Rostaing L. Hepatitis C and renal disease: epidemiology, diagnosis, pathogenesis and therapy. In Hepatitis C in Renal Disease. Hemodial Transplant. 2012;176:10-23.

Martin P, Fabrizi F. Hepatitis C virus and kidney disease. J Hepatology. 2008 Oct 1;49(4):613-24.

Fissell RB, Bragg-Gresham JL, Woods JD, Jadoul M, Gillespie B, Hedderwick SA, Rayner HC, Greenwood RN, Akiba T, Young EW. Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: the DOPPS. Kidney Intern. 2004 Jun 1;65(6):2335-42.

Ismail T, Batool K, Abbasi ZA, Khurshid T. Seroconversion of Patients Undergoing Haemodialysis from HCV Negative to HCV Positive Status. J Rawal Med CollStude Suppl. 2016;20(S-1):34-37.

Park H, Chen C, Wang W, Henry L, Cook RL, Nelson DR. Chronic hepatitis C virus (HCV) increases the risk of chronic kidney disease (CKD) while effective HCV treatment decreases the incidence of CKD. Hepatol. 2018 Feb;67(2):492-504.

Fabrizi F, Martin P, Dixit V, Messa P. Meta‐analysis of observational studies: hepatitis C and survival after renal transplant. J Viral Hepat. 2014 May;21(5):314-24.

Fabrizi F, Messa P. Treatment choices for hepatitis C in patients with kidney disease. Clin J Am Soc Nephrol. 2018 May 7;13(5):793-5.

Jadoul M, Berenguer MC, Doss W, Fabrizi F, Izopet J, Jha V, et al. Executive summary of the 2018 KDIGO Hepatitis C in CKD Guideline: welcoming advances in evaluation and management. Kidney international. 2018 Oct 1;94(4):663-73.

AASLD/IDA. HCV Guidance: Recommendations for testing, managing, and treating hepatitis C 2016. Available at: http://www.hcvguidance.org. Accessed on 30th September 2017.

European Association for Study of Liver. EASL recommendations on treatment of hepatitis C 2015. J Hepatol. 2015 Jul;63(1):199.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al.A new equation to estimate glomerular filtration rate. Ann Inter Med. 2009 May 5;150(9):604-12.

Soresi M, Giannitrapani L, Cervello M, Licata A, Montalto G. Non invasive tools for the diagnosis of liver cirrhosis. World journal of gastroenterology: WJG. 2014 Dec 28;20(48):18131.

Fabrizi F, Dixit V, Martin P, Messa P. Combined antiviral therapy of hepatitis C virus in dialysis patients: meta‐analysis of clinical trials. J Viral Hepat. 2011 Jul;18(7):e263-9.

Roth D, Nelson DR, Bruchfeld A, Liapakis A, Silva M, Monsour Jr H, et al. Grazoprevir plus elbasvir in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and stage 4-5 chronic kidney disease (the C-SURFER study): a combination phase 3 study. Lancet. 2015 Oct 17;386(10003):1537-45.

Saxena V, Koraishy FM, Sise ME, Lim JK, Schmidt M, Chung RT, et al. Safety and efficacy of sofosbuvir‐containing regimens in hepatitis C‐infected patients with impaired renal function. Liver Int. 2016 Jun;36(6):807-16.

Nazario HE, Ndungu M, Modi AA. Sofosbuvir and simeprevir in hepatitis C genotype 1-patients with end-stage renal disease on hemodialysis or GFR <30 mL/min. Liver Int. 2016;36(6):798-801.

García-Agudo R, Aoufi-Rabih S, Salgueira-Lazo M, González-Corvillo C, Fabrizi F. ‘Real-life’experience with direct-acting antiviral agents for hepatitis C virus in end-stage renal disease. The Int J Artif Org. 2018 Jul;41(7):363-70.

Dumortier J, Bailly F, Pageaux GP, Vallet-Pichard A, Radenne S, Habersetzer F, et al. Sofosbuvir-based antiviral therapy in hepatitis C virus patients with severe renal failure. Nephrol Dialys Transplant. 2016 Oct 19;32(12):2065-71.

Marcelli D, Stannard D, Conte F, Held PJ, Locatelli F, Port FK. ESRD patient mortality with adjustment for comorbid conditions in Lombardy (Italy) versus the United States. Kidney Int. 1996 Sep 1;50(3):1013-8.

Desnoyer A, Pospai D, Lê MP, Gervais A, Heurgué-Berlot A, Laradi A, et al. Pharmacokinetics, safety and efficacy of a full dose sofosbuvir-based regimen given daily in hemodialysis patients with chronic hepatitis C. J Hepat. 2016 Jul 1;65(1):40-7.

Cox‐North P, Hawkins KL, Rossiter ST, Hawley MN, Bhattacharya R, Landis CS. Sofosbuvir‐based regimens for the treatment of chronic hepatitis C in severe renal dysfunction. Hepatol Communicat. 2017 May;1(3):248-55.




How to Cite

Rasool, S., Babar, A. N., Baig, M. W., Azhar, S., & Akhtar, M. S. (2019). Efficacy and safety of sofosbuvir based antiviral therapy for chronic hepatitis C infection in patients with advanced chronic kidney disease. International Journal of Research in Medical Sciences, 7(10), 3679–3684. https://doi.org/10.18203/2320-6012.ijrms20194292



Original Research Articles