Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1352
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
Hepatitis C virus (HCV) is a significant public health issue in the United States and worldwide. The consequences of HCV infection extend beyond the liver, including renal complications. Patients with HCV are at risk for renal function decline and developing end-stage renal disease (ESRD). Chronic kidney disease (CKD) is an important public health problem as it increases the likelihood of adverse outcomes and is associated with high healthcare costs.
Given HCV infection places patients at risk for renal function decline and developing ESRD, it is valuable to understand how the clearance of HCV infection with interferon free, direct acting antiviral (DAA) therapy affects chronic kidney progression. Given the recent introduction of DAA therapy, the impact of HCV clearance on kidney disease has not been fully established.
The authors’ principal aim was to determine if the achievement of sustained virological response at 12 wk (SVR12) with interferon-free, DAAs impacts the progression of CKD.
The authors retrospectively analyzed medical records of adult patients who initiated hepatitis C treatment with interferon-free DAAs from 2014 to 2016 at the VA Greater Los Angeles Healthcare System. The control group consisted of adult patients who did not undergo hepatitis C treatment, prior to the introduction of DAAs, from 2011 to 2013. Baseline demographic and clinical data were collected. The rate of change in estimated glomerular filtration rate (eGFR) one-year after HCV treatment compared to one-year before treatment was compared between patients who achieved SVR12 to those who did not. The change in eGFR was recorded over two years in patients who did not undergo treatment and compared to those who underwent DAA treatment.
The findings of the analysis suggest that patients who achieved SVR12 with interferon-free DAAs had a reduced progression of renal disease that was statistically significant compared to patients who did not achieve SVR12. However, there were no significant differences in renal function decline between patients who were not treated with DAAs compared to those who were treated and achieved SVR12. The control group was not statistically different from the cohort of HCV treated patients, except that the there were significantly more patients with cirrhosis and obesity in the cohort who underwent HCV treatment compared to the control group. The control group, however, had significantly more patients with hypertension and congestive heart failure compared to the cohort who underwent HCV treatment.
There is a lesser decline in renal function in patients who achieved SVR12 compared to those who did not, however there were no significant differences in renal function decline between patients who were not treated compared to those who achieved SVR12. There are several possible explanations for the lack of improvement of CKD progression with viral eradication, such as immune factors related to cyroglobulins, intrinsic renal disease prior to therapy, and that the control group had significantly more patients with cirrhosis compared to the treatment group.
Additional research is needed to confirm these results in multi-institutional studies with longer duration of follow-up.