Friday, December 29, 2017

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

World J Hepatol. Dec 28, 2017; 9(36): 1352-1360 Published online Dec 28, 2017.

Impact of sustained virologic response on chronic kidney disease progression in hepatitis C
Elizabeth S Aby, Tien S Dong, Jenna Kawamoto, Joseph R Pisegna, Jihane N Benhammou

To 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.

A 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.

Five 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).

Patients who achieve SVR12 have a lesser decline in renal function, but viral eradication in itself may not be associated improvement in renal disease progression.

Core tip: In hepatitis C patients treated with direct acting antivirals, there is a lesser decline in renal function in those who are treated and achieved sustained virological response at 12 wk (SVR12) compared to those who do not achieve SVR12. However, the decline in renal function is no different between those who achieve SVR12 and those who are never treated. This suggests that viral eradication may not be associated improvement in the progression of renal disease and other factors, such as cryoglobulinemia, may be implicated in renal disease progression.

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