Hepatitis C virus (HCV) is a significant cause of chronic liver disease worldwide [1]. About 71.1 million people have chronic HCV infection, accounting for 1 % of the population [2].

Several factors contribute to the development of renal disease in chronic HCV patients. A cascade of immune reactions may be triggered by HCV and then attack the kidneys leading to glomerulonephritis. Moreover, insulin resistance and dyslipidemia are associated with HCV [3], thus, increasing the risk of renal disease. Additionally, the risk of acquiring HCV infection is more common inpatients with end-stage renal disease (ESRD) and patients on hemodialysis [4]. Finally, renal transplant recipients with HCV have higher mortality rates and renal graft loss [5].

The development of direct-acting antiviral (DAA)drugs for chronic HCV infection wasone of the most significant advances in medicine in the last decade; it has several benefits, such as high efficacy (SVR rates >95 %) with minimal side effects, good tolerability, short treatment duration (8–12 weeks), and easy drug administration (once-daily oral dosing) [6].

According to the Egyptian demographic health survey in 2015, HCV seroprevalence in adults was 6.3 % [7], but the latest Egyptian mass screening showed 4.61 % [8].

A combination of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) was approved by FDA in 2015 to be used with ribavirin (RBV) to treat chronic HCV patients. Paritaprevir (PTV) is HCV NS3/4A protease inhibitor with activities against genotypes 1a, 1b, 4a, and 6a. Ritonavir is an inhibitor of HIV-1 protease and acts as a pharmacokinetic booster of paritaprevir. Similarly, ombitasvir (OBV) is an HCV NS5A inhibitor with pan-genotypic efficacy against genotypes 1a, 1b, 2a, 2b, 3a, 4a, and 5a [9].

According to EASL guidelines 2018, in patients with mild to moderate renal impairment (eGFR30-60 ml/min/1.73 m2), dose adjustments are not necessary for any of the approved DAAs, while in patients with severe renal dysfunction (eGFR < 30 ml/min/1.73 m2) the safety of sofosbuvir (SOF) is questioned as it is eliminated mainly by the kidney and not recommended for patients requiring hemodialysis. Therefore, for those patients with ESRD, SOF-free regimens are preferred [10], and several trials confirmed those regimens, including ritonavir-boosted PTV, OBV, and dasabuvir, were effective and safe [11]. The combination of grazoprevir/elbasvir was studied for 12 weeks ingenotype1infected patients with ESRD and showed a sustained virological response rate (SVR) of 99 % with high tolerability and low incidence of adverse events [12]. Clinical trials of glecaprevir/pibrentasvir revealed good efficacy and safety in patients with stage 4–5 chronic kidney disease (CKD) [13].

This study aimed to evaluate the efficacy and safety of OBV/PTV/r-based therapy in chronic HCV patients with CKD.