1. Direct-acting antiviral therapy slows kidney function decline in patients with Hepatitis C virus infection and chronic kidney disease.
- Author
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Sise ME, Chute DF, Oppong Y, Davis MI, Long JD, Silva ST, Rusibamayila N, Jean-Francois D, Raji S, Zhao S, Thadhani R, and Chung RT
- Subjects
- Acute Kidney Injury blood, Acute Kidney Injury chemically induced, Adult, Aged, Albuminuria diagnosis, Albuminuria urine, Albuminuria virology, Antiviral Agents adverse effects, Creatinine blood, Disease Progression, Female, Glomerular Filtration Rate drug effects, Hepacivirus pathogenicity, Hepatitis C, Chronic complications, Hepatitis C, Chronic urine, Hepatitis C, Chronic virology, Humans, Male, Middle Aged, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic urine, Renal Insufficiency, Chronic virology, Retrospective Studies, Treatment Outcome, Acute Kidney Injury epidemiology, Albuminuria drug therapy, Antiviral Agents administration & dosage, Hepatitis C, Chronic drug therapy, Renal Insufficiency, Chronic drug therapy
- Abstract
Hepatitis C virus (HCV) infection is common and can accelerate chronic kidney disease (CKD) progression. Direct-acting antiviral (DAA) therapies against hepatitis C have consistently shown rates of sustained viral remission. However, the effect on kidney function is unknown. In a retrospective observational cohort study of HCV-infected patients receiving DAA therapies from 2013 to 2017, the slopes of estimated glomerular filtration rate (eGFR) decline were compared in the three years before DAA therapy to the slope after therapy. Pre- and post-treatment albuminuria values were also compared. In all, 1,178 patients were included; mean age of 56, 64% male, 71% white, 21% were diabetic, and 42% with cirrhosis. In patients with eGFR less than 60ml/min per 1.73m
2 , the annual decline in eGFR in the three years prior to treatment was -5.98 ml/min per year (95% confidence interval -7.30 to -4.67) and improved to -1.32 ml/min per year (95% confidence interval -4.50 to 1.88) after DAA therapy. In patients with eGFR greater than 60ml/min per 1.73m2 the annual decline in eGFR in the three years prior to treatment was -1.43 ml/min per year (95% confidence interval -1.78 to -1.08) and after DAA therapy was -2.32 ml/min per year (95% confidence interval -3.36 to -1.03). Albuminuria improved significantly in patients without diabetes, but not in those with diabetes. Predictors of eGFR improvement included having CKD at baseline and being non-diabetic. Events of acute kidney injury were rare, occurring in 29 patients, and unrelated to antiviral therapy in 76% of cases. Thus, DAA therapy for HCVs infection may slow CKD progression., (Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)- Published
- 2020
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