Interferon-free regimens improve kidney function in patients with chronic hepatitis C infection
- 20 Downloads
Background and aim
The impact of directly acting antiviral agent (DAA) regimens on renal function is not well defined and quite controversial. We evaluated the effect of DAAs on kidney function and the factors associated with an improvement or worsening.
Patients and methods
The changes in estimated glomerular filtration rate (eGFR) in a cohort of 403 patients treated with a DAA regimen were evaluated.
The overall sustained virological response (SVR12) rate was 98%. The median eGFR progressively increased throughout treatment from 84.54 ml/min/1.73 m2 (IQR 70.8–97.3) to 88.12 ml/min/1.73 m2. Conversely, rates of patients with a eGFR more than 60 ml/min/1.73 m2 progressively increased from 83.1% at baseline to 87.8% at 12 weeks post-treatment (p < 0.05). Considering the change in eGFR according to the different factors, a significant improvement in eGFR was observed in the patients without diabetes (p < 0.001), in those with cirrhosis (p < 0.05), in those receiving a Sof-based regimen (p < 0.01) or not receiving RBV (p < 0.05), in those with a baseline eGFR less than 60 ml/min/1.73 m2 (p < 0.001) and in those with SVR (p < 0.05). An improvement in eGFR (defined as an increase in baseline eGFR of at least 10 ml/min/1.73 m2) was observed in 148 patients (36.7%). At multivariate analysis, age (aHR 0.96; 95 CI 0.93–0.99, p < 0.01) and a diagnosis of diabetes (aHR 0.02; 95 CI 0.20–0.87, p < 0.05) were inversely and independently associated with improvement in renal function, while the presence of Child–Pugh B cirrhosis at baseline was associated with an improvement in renal function (aHR 3.07; 95 CI 1.49–6.30, p < 0.01).
DAAs correlate with an improvement in renal function, underlining the importance of hepatitis C virus eradication to achieve also an improvement in extra-hepatic disorders.
KeywordsDAA Renal function CKD HCV infection eGFR
Hepatitis C virus
Chronic kidney disease (CKD)
End-stage renal disease
Sustained virological response
Directly acting antiviral agents
Estimated glomerular filtration rate
Chronic Kidney Disease Epidemiology Collaboration
Kidney Disease Improving Global Outcome
1-Month of therapy
End of treatment
Week 12 after the end of treatment
- 95 CI
95% confidence interval
Adjusted hazard ratio
NC, IG and FP were responsible for the conception and design of the study and wrote the manuscript; ARB, CC and GB participated in the conception of the study and interpreted the data; LS, GP, SDP, SM, DCA and MP enrolled and followed up the patients; RS interpreted and analyzed the data and performed the statistical analysis. All the authors read and approved the manuscript.
This study was supported by a Grant from University of Campania (Grant no. 2017). NC received Grants from ViiV Healthcare, Janssen-Cilag, and Gilead Sciences; personal fees from Gilead Sciences, Abbvie, Bristol-Myers Squibb and Merck Sharp & Dohme IG was consultant for Abbvie, MSD and Cardiome. He received a Grant (in the framework of Fellowship program) from Gilead Sciences.
Compliance with ethical standards
Conflict of interest
All the authors of the manuscript declare that they have no conflict of interest in connection with this paper.
The study was approved by Ethical Committee of University Federico II of Naples (no. 259/2018). All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
- 4.Latt N, Alachkar N, Gurakar A (2012) Hepatitis C virus and its renal manifestations: a review and update. Gastroenterol Hepatol 8:434–445Google Scholar
- 8.Minutolo R, Aghemo A, Chirianni A et al (2018) Management of hepatitis C virus infection in patients with chronic kidney disease: position statement of the joint committee of Italian association for the study of the liver (AISF), Italian society of internal medicine (SIMI), Italian society of infectious and tropical disease (SIMIT) and Italian society of nephrology (SIN). J Nephrol 31:685–712CrossRefGoogle Scholar
- 13.Coppola N, Gentile I, Pasquale G et al (2013) Anti-HBc positivity was associated with histological cirrhosis in patients with chronic hepatitis C. Ann Hepatol 13:20–26Google Scholar
- 26.Stevens PE, Levin A (2013) Kidney disease: improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med 158:825–830CrossRefGoogle Scholar