Summary: Patients with Renal Impairment
Recommendation for Patients With CKD Stagea 1, 2, or 3
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RECOMMENDED
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RATING 
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No dose adjustment in direct-acting antivirals is required when using recommended regimens.b
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I, A
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a Chronic kidney disease (CKD) stages: 1 = normal (eGFR >90 mL/min); 2 = mild CKD (eGFR 60-89 mL/min); 3 = moderate CKD (eGFR 30-59 mL/min); 4 = severe CKD (eGFR 15-29 mL/min); 5 = end-stage CKD (eGFR <15 mL/min)
b A dose adjustment in ribavirin may be required in patients with CKD stage 3; see package insert for details.
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Recommended regimens listed by evidence level and alphabetically for:
Patients With CKD Stagea 4 or 5 (eGFR <30 mL/min or End-Stage Renal Disease)
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RECOMMENDED
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GENOTYPE
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DURATION
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RATING
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Daily fixed-dose combination of elbasvir (50 mg)/grazoprevir (100 mg)
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1a, 1b, 4
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12 weeks
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I, A
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Daily fixed-dose combination of glecaprevir (300 mg)/pibrentasvir (120 mg)b
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1, 2, 3, 4, 5, 6
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8 to 16 weeksc
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I, Ac
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Daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)
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1, 2, 3, 4, 5, 6
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12 weeks
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1,Bd
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a Chronic kidney disease (CKD) stages: 1 = normal (eGFR >90 mL/min); 2 = mild CKD (eGFR 60-89 mL/min); 3 = moderate CKD (eGFR 30-59 ml/min); 4 = severe CKD (eGFR 15-29 mL/min); 5 = end-stage CKD (eGFR <15 mL/min)
b Dosing is 3 coformulated tablets (glecaprevir [100 mg]/pibrentasvir [40 mg]) taken once daily. Please refer to the prescribing information.
c Patients in this group should be treated as would patients without CKD. Duration of glecaprevir/pibrentasvir should be based on presence of cirrhosis and prior treatment experience (please refer to appropriate section). As such, strength of rating may be lower for certain subgroups.
d All patients with stage 5 CKD on chronic dialysis with the majority on hemodialysis
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