Direct-acting antiviral (DAA) agents have been a game changer in chronic hepatitis C virus (HCV) treatment, producing a sustained viral response in most patients. According to new study findings presented at the American Society of Nephrology’s Kidney Week 2021, DAA therapy also protects the kidneys and reduces the risk for end-stage kidney disease (ESKD).
Among 114,358 veterans (mean age 55 years; 97% male; 38% Black) with HCV infection, 58,045 (51%) received a course of DAA therapy from 2013 to 2018. Their mean estimated glomerular filtration rate (eGFR) was 92 mL/min/1.73 m2 and 8% had proteinuria. Over 11.5 years, 497 ESKD events and 26,684 composite events of ESKD or death occurred.
DAA therapy was associated with a significant 57% and 38% lower risk of ESKD and the composite outcome, respectively, compared with no DAA therapy, Csaba P. Kovesdy, MD, of The University of Tennessee Health Science Center in Memphis reported on behalf of his team.
“Our results show that DAA treatment is associated with significantly lower risk of kidney failure and death, which add to the mounting evidence about the usefulness of such therapy and emphasize the need to make it available to all affected patients,” Dr Kovesdy said in an interview with Renal & Urology News.
He noted that nephrologists care for patients on dialysis, who are among those with the highest risk for HCV, and are thus in a prime position to identify infected patients and to refer them for treatment with DAAs. “This requires vigilance in the form of proactive screening and good partnership with hepatologists specializing in DAA therapy,” Dr Kovesdy said.
In recent years, DAA therapy has enabled HCV kidney transplantation, including in uninfected recipients. It represents another strategy for reducing organ shortage and transplant waiting time.
“Kidney transplantation is the preferred renal replacement therapy, with organ shortage being the biggest impediment to its widespread use,” Dr Kovesdy said. “The ability to transplant HCV-infected kidneys into HCV-negative recipients using DAA therapy opened up a substantial pool of kidneys that was previously being discarded and contributed to a substantial increase in the number of kidney transplants.”
Thomas F, Potukuchi PK, Dashputre AA, Sumida K, et al. Renal outcomes associated with direct acting antiviral therapy in patients with hepatitis C virus infection. Presented at: Kidney Week 2021; November 2-7, 2021. Oral presentation: FR-OR55.