Direct acting antiviral HCV treatment does not influence renal function

Abstract

HCV infection is associated with chronic kidney disease due to several mechanisms. Patients treated with interferon-based regimens demonstrate improved renal function and reduced incidence of chronic kidney disease. There is scarce evidence on the effect of direct acting antiviral regimens (DAAs) on renal function. We evaluated serial measures of renal function in a cohort of HCV-infected participants following completion of DAA-based treatment regimens. Measures of glomerular filtration rate (GFR) were estimated by the CKD-EPI equation. Data was recorded at end of treatment, and at 6–12 months, 12–24 months, and greater than 24 months following treatment completion. Group-based trajectory modeling was used to determine distinct GFR trajectories. Predictors of group membership were determined by multinomial regression analysis. Six trajectories were identified. One trajectory comprising 27% of the cohort demonstrated declining renal function and the others demonstrated no change in renal function over time. Baseline GFR did not predict SVR. Diabetes was associated with lower post-treatment GFR but patients with diabetes did not demonstrate a decrease in GFR over the period of evaluation. Cirrhosis and SVR were not significant predictors of GFR or GFR trajectory. There is no clinically relevant change in renal function among the majority of HCV-infected patients following completion of DAA-based treatments. Renal function does not influence the efficacy of DAA-based regimens. No consistent effect of DAA treatment and/or SVR on renal function was observed over a 2-year period following treatment completion.

Effectiveness of Direct-Acting Antivirals in Treatment of Elderly Egyptian Chronic Hepatitis C Patients

“…Historically, HCV has been difficult to treat in elderly patients due to its association with rapid progressive fibrosis and cirrhosis, along with a higher incidence of liver cancer compared to younger patients [10,11]. Additionally, there is an increased exposure risk of drug interactions between multiple concomitant medications for different common comorbidities in the elderly [12].…”

National trends and outcomes of heart‐kidney transplantation using hepatitis C positive donors

“…Other studies have shown that these therapies are effective and safe in patients with chronic hepatitis C infection who have end‐stage renal disease or have received a kidney transplant 26 . In addition, another analysis demonstrated that renal function was not impacted by DAAs in HCV‐infected patients 27 . In our analysis, we did not have data regarding longer‐term renal function, however, the postoperative dialysis rates were similar between HCV+ and HCV‐ cohorts.…”

“…26 In addition, another analysis demonstrated that renal function was not impacted by DAAs in HCV-infected patients. 27 In our analysis, we did not have data regarding longer-term renal function, however, the postoperative dialysis rates were similar between HCV+ and HCV-cohorts. An important point is that not all patients likely seroconverted or received these therapies as most centers reserve DAA therapy for heart transplant recipients who seroconvert following HCV+ donor implantation.…”

Long‐term risk of end‐stage renal diseases with maintenance dialysis among chronic hepatitis C patients after antiviral therapy in Taiwan

“…Recent study demonstrated that sofosbuvir-based therapy had transient eGFR decline during therapy with improvement off treatment. 32 The other studies showed no clinically relevant change in renal function among the majority of CHC patients received both sofosbuvir-based or sofosbuvir-free regimens, even until 24 months of post-treatment 33 or among patients with existing CKD, 34 and is safe and effective for ESRD HCV patients under maintenance hemodialysis. 35 However, long-term effects of direct acting antiviral on renal outcome remains unclear.…”