Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2017; 9(36): 1352-1360
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1352
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
Elizabeth S Aby, Tien S Dong, Jenna Kawamoto, Joseph R Pisegna, Jihane N Benhammou, Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
Elizabeth S Aby, Tien S Dong, Joseph R Pisegna, Jihane N Benhammou, the Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Los Angeles, Department of Medicine, University of California David Geffen School of Medicine, Los Angeles, CA 90095, United States
Author contributions: Aby ES, Dong TS, Kawamoto J, Pisegna JR and Benhammou JN were involved in study concept and design; Aby ES and Dong TS were involved in data acquisition; Aby ES, Dong TS and Benhammou JN were involved in analysis and interpretation of data; Aby ES drafted the manuscript; Dong TS, Pisegna JR and Benhammou JN were involved in critical revision of the manuscript for important intellectual content; Dong TS performed the statistical analysis; Pisegna JR provided administrative, technical and material support as well as study supervision.
Supported by Department of Veterans Affairs RR and D Merit Review, No. I01 RX000194 (to Pisegna JR); Human Studies CORE through CURE: Digestive Diseases Research Center supported by NIH grant; Nos. P30DK41301 (to Pisegna JR) and NIH T32 DK07180-43 (to Benhammou JN).
Institutional review board statement: This study was approved by the VA Institutional Review Board and the Research and Development Committee at VA Greater Los Angeles Health System (VAGLAHS). Tracking Number 2016-100938.
Informed consent statement: Due to the retrospective nature of this study, an exempt for informed consent was approved by the VA institutional review board.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jihane N Benhammou, MD, the Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States. jbenhammou@mednet.ucla.edu
Telephone: +1-310-2683131 Fax: +1-310-2684096
Received: October 6, 2017
Peer-review started: October 6, 2017
First decision: November 7, 2017
Revised: November 17, 2017
Accepted: December 5, 2017
Article in press: December 6, 2017
Published online: December 28, 2017
Abstract
AIM

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

Keywords: Hepatitis C, Direct-acting antivirals, Chronic kidney disease, End stage renal disease, Sustained virological response

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.