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Limited data are available on direct-acting antivirals for treating hepatitis C virus ( HCV) infection in patients with severe renal impairment. The aim of this study was to evaluate the effectiveness and safety of ombitasvir/paritaprevir/ritonavir ( OBV/ PTV/r) ± dasabuvir ( DSV) ± ribavirin ( RBV) in patients with stage 4 or 5 chronic kidney disease ( CKD) and HCV genotype 1 or 4 infection in real clinical practice, and to investigate pharmacological interactions. This retrospective study included patients treated with OBV/ PTV/r+ DSV± RBV or OBV/ PTV/r+ RBV with CKD stage 4 ( eGFR: 15-29 mL/min/1.73m2) or 5 ( eGFR<15 mL/min/1.73m2 or requiring dialysis) and HCV infection by genotypes 1 and 4 between April 2015 and October 2015 in nine Spanish centres. Sustained virological response at 12 weeks ( SVR12) was assessed, and clinical and laboratory data, fibrosis stage, adverse events and pharmacological interactions were reported. Forty-six patients were included: 10 (21.7%) had CKD stage 4 and 36 (78.2%) CKD stage 5. Seventeen (36.9%) had cirrhosis. SVR12 rate in the intention-to-treat population was 95.7%. Twenty-one (45.6%) received RBV, which was discontinued in two (9.5%) patients. Anaemia (haemoglobin <10 g/dl) occurred in 12 patients (57.1%) with RBV vs 10 (40.0%) without RBV ( P=.246). Renal function remained stable during antiviral therapy. Nine patients (19.5%) experienced serious adverse events unrelated to antiviral therapy. Concomitant medication was discontinued or modified in 41.3% of patients. In conclusion, the effectiveness of OBV/ PTV/r± DSV± RBV in patients with CKD 4-5 was similar to that observed in those with normal renal function and was not associated with severe adverse events. [ABSTRACT FROM AUTHOR]