. 2016 Jul 7;5(3):313–327. doi: 10.1007/s40121-016-0116-z

Table 2.

Recent published guidelines for use of DAAs in CKD patients with comments from the latest publications

AASLD 2015
For patients with mild to moderate renal impairment (GFR >30–80 ml/min), no dosage adjustment is required when using sofosbuvir, simeprevir, a fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) or fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) to treat or retreat HCV infection in patients with appropriate genotypes (I-A)
For treatment-naive patients with HCV genotype 1 without cirrhosis with GFR <30 ml/min, treatment with the daily fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) with (1a) or without (1b) RBV (200 mg) once daily is recommended RBV should only be given if the baseline hemoglobin level is greater than 10 g/dl For patients with moderate renal impairment (eGFR 30–50 ml/min), initial RBV dosing should be 200 or 400 mg alternating every other day For patients with severe renal impairment or who are on hemodialysis (eGFR <30 ml/min), initial RBV dosing should be 200 mg daily (II-B)

AASLD 2015

For patients with mild to moderate renal impairment (GFR >30–80 ml/min), no dosage adjustment is required when using sofosbuvir, simeprevir, a fixed-dose combination of ledipasvir (90 mg)/sofosbuvir (400 mg) or fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) to treat or retreat HCV infection in patients with appropriate genotypes (I-A)

For treatment-naive patients with HCV genotype 1 without cirrhosis with GFR <30 ml/min, treatment with the daily fixed-dose combination of paritaprevir (150 mg)/ritonavir (100 mg)/ombitasvir (25 mg) plus twice-daily dosed dasabuvir (250 mg) with (1a) or without (1b) RBV (200 mg) once daily is recommended

RBV should only be given if the baseline hemoglobin level is greater than 10 g/dl

For patients with moderate renal impairment (eGFR 30–50 ml/min), initial RBV dosing should be 200 or 400 mg alternating every other day

For patients with severe renal impairment or who are on hemodialysis (eGFR <30 ml/min), initial RBV dosing should be 200 mg daily (II-B)

EASL 2015 Hepatitis C guidelines in hemodialysis patients
Simeprevir, daclatasvir and the combination of ritonavir-boosted paritaprevir, ombitasvir and dasabuvir are cleared by hepatic metabolism and can be used in patients with severe renal disease (A1)
Sofosbuvir should not be administered to patients with an eGFR <30 ml/min/1.73 m² or with end-stage renal disease until more data are available (B2)
The need for dose adjustments for the approved HCV DAAs in patients on dialysis is unknown. No safety dosing and efficacy data are available in this population These drugs should thus be used with extreme caution in patients with severe renal disease and only in extreme life-threatening situations for patients on dialysis (B1)
Hemodialysis patients, particularly those who are suitable candidates for renal transplantation, should be considered for antiviral therapy (B1) Hemodialysis patients should receive an IFN-free, if possible ribavirin-free regimen for 12 weeks in patients without cirrhosis, for 24 weeks in patients with cirrhosis (B1)