Impact of sustained virologic response on chronic kidney disease progression in hepatitis C

Abstract

AIMTo determine how sustained virological response at 12 wk (SVR12) with direct acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection affects chronic kidney disease (CKD) progression.METHODSA retrospective analysis was performed in patients aged ≥ 18 years treated for HCV with DAAs at the VA Greater Los Angeles Healthcare System from 2014-2016. The treatment group was compared to patients with HCV from 2011-2013 who did not undergo HCV treatment, prior to the introduction of DAAs; the control group was matched to the study group in terms of age, gender, and ethnicity. Analysis of variance and co-variance was performed to compare means between SVR12 subgroups adjusting for co-variates.RESULTSFive hundred and twenty-three patients were evaluated. When comparing the rate of change in estimated glomerular filtration rate (eGFR) one-year after HCV treatment to one-year before treatment, patients who achieved SVR12 had a decline in GFR of 3.1 mL/min ± 0.75 mL/min per 1.73 m2 compared to a decline in eGFR of 11.0 mL/min ± 2.81 mL/min per 1.73 m2 in patients who did not achieve SVR12 (P = 0.002). There were no significant clinical differences between patients who achieved SVR12 compared to those who did not in terms of cirrhosis, treatment course, treatment experience, CKD stage prior to treatment, diuretic use or other co-morbidities. The decline in eGFR in those with untreated HCV over 2 years was 2.8 mL/min ± 1.0 mL/min per 1.73 m2, which was not significantly different from the eGFR decline noted in HCV-treated patients who achieved SVR12 (P = 0.43).CONCLUSIONPatients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.

Eradication of hepatitis C virus infection in kidney transplant recipients using direct‐acting antiviral therapy: Qatar experience

“…Despite the promising results of HCV eradication by DAA therapy in kidney transplant recipients, it remains unclear whether SVR will prevent long‐term complications of HCV infection, such as glomerulonephritis and posttransplant diabetes mellitus (PTDM) 27 . In our cohort, five patients developed PTDM before ( n = 4) or during ( n = 1) DAA therapy.…”

“…Of note, patients who completed the 1‐year follow‐up did not show a significant decline in eGFR; in fact, many recipients showed an improvement in kidney function. Aby et al 27 evaluated the progression of native CKD after DAA therapy and compared the findings with those for untreated patients; there was no significant difference in kidney function between the two groups at the 2‐year follow‐up.…”

Renal function trajectories in hepatitis C infection: differences between renal healthy and chronic kidney disease individuals

“…However, the HCV infection remained significant risk factor of eGFR decline after adjusting for age, gender, hypertension, diabetes, baseline eGFR and UPCR in the normal renal function subjects of our study. In addition, interventional studies have indicated that reductions of viral load were associated with improvement of renal function in patients receiving antiviral treatment 7 , 29 , 36 – 39 , implicating an independent role of HCV in inducing renal damage from very early stage of disease.…”

Therapy of Chronic Viral Hepatitis: The Light at the End of the Tunnel?

“…All approved DAAs can be used in patients with mild-tomoderate renal impairment [144], and recently the exclusion of sofosbuvir-based therapies in patients with severe renal impairment has been removed [145]. The great majority of studies published so far [146][147][148][149][150][151][152][153] have shown that DAAs are effective in lowering the risk of kidney disease in HCV-positive patients and in stabilizing/improving renal function in patients with CKD, even though the long-term impact on kidney survival is still largely unknown [93].…”