Treatment for HCV Slows Progression of CKD

Full access

Direct-acting antiviral therapy for hepatitis C virus (HCV) slows the decline in kidney function for patients with comorbid chronic kidney disease (CKD), reports a study in Kidney International.

The retrospective study included 1178 HCV-infected patients who started DAA therapy between 2013 and 2017. All included patients were compliant with DAA treatment, had not undergone organ transplantation or started dialysis, and had available data on baseline creatinine. The patients’ mean age was 46 years; 64% were male and 71% were white, 42% had cirrhosis, and 21% had diabetes. The slope of decline in estimated glomerular filtration rate (eGFR) was compared for the 3 years before to after DAA therapy.

At baseline, 115 patients had an eGFR of less than 60 mL/min/1.73 m2. In this group, the annual decline in eGFR for the 3 years before treatment was −5.98 mL/min per year, improving to −1.32 mL/min per year after DAA therapy. Patients with normal baseline kidney function had no significant change in rate of eGFR decline from before to after DAA treatment: −1.43 to –2.33 mL/min per year.

Improvement in albuminuria after DAA therapy occurred only in diabetic patients. Baseline CKD was a significant predictor of improvement in eGFR, as was the absence of diabetes. Acute kidney injury occurred in 29 patients but was considered “possibly related to DAAs” in less than one-fourth of cases.

New DAA medications are highly effective in curing HCV infection. Hepatitis C virus can accelerate progression of CKD. However, little is known about the short- or long-term effects of DAA treatment on eGFR.

The new findings suggest that, among patients with CKD, treatment with DAA for HCV infection leads to improvement in the slope of eGFR decline. Longer follow-up will be needed to assess the impact of DAA therapy on progression to kidney failure [Sise M, et al. Direct-acting antiviral therapy slows kidney function decline in patients with hepatitis C virus infection and chronic kidney disease. Kidney Int 2020; 97:193–201].