Direct-acting antiviral therapy can slow kidney function decline in patients with hepatitis C (HCV) and chronic kidney disease (CKD), according to new study findings published in Kidney International.
Meghan E. Sise, MD, MS, of Massachusetts General Hospital in Boston, and collaborators conducted a retrospective study of 1178 patients (mean age 56 years) from Partners Healthcare. In the 115 patients with an estimated glomerular filtration (eGFR, mL/min/1.73m2) less than 60, eGFR declined significantly more slowly in the 3 years after direct-acting antiviral (DAA) therapy: by 5.98 per year before treatment and by 1.32 per year after treatment. In the 1063 patients with an eGFR greater than 60, eGFR declined by 1.43 and 2.32 per year, respectively — a nonsignificant change.
Overall, hepatitis C patients with stage 3 CKD and no diabetes had a 4.3- and 1.8-fold improvement in eGFR, respectively, with antiviral therapy. Albuminuria improved significantly in patients without diabetes, but remained unchanged in those with diabetes.
DAA regimens were based on viral genotype, prior treatment, presence of cirrhosis (in 42% of cohort), and preference. Most patients (97%) received a sofosbuvir-based regimen. Ribavirin was used in 28%, and interferon was used in only 3%. Newer therapies, such as elbasvir and grazoprevir or glecaprevir and pibrentasvir, were not commonly used. Most patients were prescribed 8 to 12 weeks of DAA therapy.
Acute kidney injury (AKI) occurred in 29 patients, or 2.6% overall. Only a quarter of AKI cases were possibly related to DAA therapy.
“This is the first analysis showing that DAAs may slow the rapid decline in eGFR associated with chronic HCV infection,” Dr Sise and the team stated. “In the era of DAAs, HCV infection may be a reversible risk factor for CKD progression.”
Sise ME, Chute DF, Oppong Y, et al. Direct-acting antiviral therapy slows kidney function decline in patients with Hepatitis C virus infection and chronic kidney disease. Kid Intl. doi:10.1016/j.kint.2019.04.030