Table 2.

Dosage recommendations for patients with mild, moderate, or severe renal insufficiency or end-stage renal disease

HCV drug	Normal renal function	Degree of renal impairment				Removed by dialysis?
	GFR >90 mL/min	Mild (GFR 50-89 mL/min))	Moderate (GFR 30-49 mL/min)	Severe (GFR 15-29 mL/min)	ESRD (GFR <15 mLl/min)
Simeprevir	150 mg od [11]	150 mg od [11]	150 mg od[11]	150 mg od[11]a	150 mg od[11]a	No
Asunaprevirb	100 mg bid [17]	100 mg bid [17]	100 mg bid [17]	100 mg od [17]	100 mg bid [17, 70]	Unknown
Daclatasvir	60 mg od [18]	60 mg od [18]	60 mg od [18]	60 mg od [18] or 30mg od in combination with asunaprevir [17]	60 mg od[18]	No
Sofosbuvir	400 mg od [23]	400 mg od [23]	400 mg od [23]	400 mg od [31, 32]c	400mg QD [26, 31, 32] c	Yes, administer after dialysis
Velpatasvir/sofosbuvirb	100 mg od/400 mg od [37]	Unknown	Unknown	Unknown	Unknown	Unknown
Sofosbuvir	90 mg od/400 mg od [21]	90 mg od/400 mg od [21]	90 mg od/400 mg od [21]	Unknown	Unknown	Ledipasvir = no [21] GS-331007 = yes [23]
Grazoprevir/elbasvir	100 mg od/50 mg od [50]	100 mg od/50 mg od [50]	100 mg od/50 mg od [50]	100 mg od/50 mg od [50]	100 mg od/50 mg od [50]	Elbasvir = no Grazoprevir = negligible [32, 50]
Ombitasvir/paritaprevir/ritonavir	25 mg od/150 mg od/100 mg od [51]	25 mg od/150 mg od/100 mg od [51]	25 mg od/150 mg od/100 mg od [51]	25 mg od/150 mg od/100 mg od [51]	25 mg od/150 mg od/100 mg od [80]	Unknown
Dasabuvir	250 mg bid [53]	250 mg bid [53]	250 mg bid [53]	250 mg bid [53]	250 mg bid [80]	Unknown
Ribavirin	<75 kg = 500 mg bid≥75 kg = 600 mg bid [56]	<75 kg = 500 mg bid≥75 kg = 600 mg bid [56]	Loading dose: <75 kg = 50 0mg bid for 1 day ≥75kg = 600 mg bid for 1 day. Followed by alternating 200 and 400 mg od [95] TDM ribavirind	Loading dose: <75kg = 500mg bid for 1 day ≥75kg = 600mg bid for 1 day. Followed by 200mg od [95] TDM ribavirind	Loading dose: <75kg = 500 mg bid, for 1 day ≥75kg = 600 mg bid for 1 day. Followed by 200 mg od [95] TDM ribavirind	No [56]

bid twice daily, Cl _cr creatinine clearance, DAA direct-acting antiviral, eGFR estimated glomular filtration rate, ESRD end-stage renal disease, FDA Food and Drug Administration, GFR Glomerular filtration rate, HCV hepatitis C virus, SmPC summary of product characteristics

^a The SmPC for OLYSIO^TM states that exposure may be increased in HCV-infected patients with severe renal impairment, caution is recommended when prescribing OLYSIO^TM to these patients

^b No SmpC or FDA prescribing information was available at the time of publication

^c The SmPC for Solvaldi® (Gilead Sciences, Inc, Foster City, CA, USA) stat that the safety and appropriate dose of Sovaldi® have not been established in patients with severe renal impairment (eGFR <30 mL/min/1.73 m²) or ESRD requiring hemodialysis. These recommendations are made when no other DAA regimen is available

^d The SmPC for Rebetol® (Merck & Co., Inc., Whitehouse Station, NJ, USA), states that patients with Cl_cr <50 mL/min must not be treated with Rebetol®. The prescribing information for Copegus® (Genentech USA, Inc., South San Francisco, CA, USA) states that the dose should be reduced in patients with Cl_cr <50 mL/min as described in the table. No loading dose is advised (expert opinion)