HCV in chronic kidney disease: a shifting paradigm in management

Hepatitis C virus (HCV) remains an important comorbidity in chronic kidney disease (CKD), particularly among patients on dialysis. Despite gains in infection prevention and antiviral therapy, transmission and care gaps persist in many settings. To summarize current epidemiology, screening, treatment options, infection-prevention practices, and key complications of HCV in dialysis populations. Narrative review of guideline and peer-reviewed literature on HCV in advanced CKD and dialysis, with emphasis on direct-acting antivirals (DAAs) and infection-prevention measures. Multiple DAA regimens demonstrate high sustained virologic response (SVR) in advanced CKD, including patients on dialysis, with improved tolerability versus interferon. Early detection and strict infection-prevention practices in dialysis units remain central to reducing transmission. Important gaps—particularly in access to DAAs, implementation of prevention bundles, and data from low-resource settings—limit universal adoption. Management of HCV in dialysis has improved with DAAs and standardized infection-prevention, but residual disparities and operational constraints remain. Pragmatic policies to expand access, reinforce infection-prevention, and integrate HCV care with transplant planning are needed.