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Hepatitis C Infection and Chronic Renal Diseases

Norberto Perico^*,, Dario Cattaneo^*,, Boris Bikbov, and Giuseppe Remuzzi^*,

^* Department of Medicine and Transplantation Ospedali Riuniti di Bergamo–Mario Negri Institute for Pharmacological Research, Bergamo, Italy; Center for Research on Organ Transplantation "Chiara Cucchi De Alessandri & Gilberto Crespi," Bergamo, Italy; and Chair of Nephrology, Moscow State University of Medicine and Dentistry, Moscow, Russia

Correspondence: Dr. Giuseppe Remuzzi, Mario Negri Institute for Pharmacological Research, Via Gavazzeni 11, 24125 Bergamo, Italy. Phone: +39.035.319888; Fax: +39.035.319331; E-mail: gremuzzi{at}marionegri.it

More than 170 million people worldwide are chronically infected with the hepatitis C virus (HCV), which is responsible for over 1 million deaths resulting from cirrhosis and liver cancers. Extrahepatic manifestations are also relevant and include mixed cryoglobulinemia, lymphoproliferative disorders, and kidney disease. HCV infection is both a cause and a complication of chronic kidney disease, occurring largely in the context of mixed cryoglobulinemia. This infection also represents a major medical and epidemiologic challenge in patients with end-stage renal disease on renal replacement therapy with dialysis or transplantation. In these settings the presence of HCV correlates with higher rates of patient mortality than in HCV-negative subjects on dialysis or undergoing kidney transplant. The major concern is the lack of safe and effective drugs to treat HCV-infected patients with chronic kidney disease. Unfortunately, there are no large-scale clinical trials in this population, especially those receiving renal replacement therapy, so that strong evidence for treatment recommendations is scant. This review article provides the readers with the most recent insights on HCV infection both as cause and complication of chronic kidney disease, discusses pitfalls and limitations of current therapies, and reports on preliminary experience with novel therapeutic agents, as well as directions for future research.