High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents
Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.
The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.
Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.
The patients’age was 49.2 ± 12 years. Baseline serum creatinine was 3.76 ± 1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97); p = 0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35); p = 0.001].
Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.
KeywordsChronic kidney disease HCV infection Sofosbuvir Daclatasvir Acute renal failure DAA therapy
The authors acknowledge the HCV working group (Urology and Nephrology teams), Egyptian Liver Research Institute team and Egyptian Medical Insurance System for supplying the DAAs.
AYE wrote the paper, HMEM and MEM helped in data collection, KFE followed up regarding hemodialysis; the work was under supervision of MAB and he reviewed the article. LR reviewed and finalized the paper.
Not funded. Mansoura Urology and Nephrology Center supported the immunosuppressive drugs and full laboratory and radiology investigations for the patients. Egyptian Liver Research Institute and Hospital afforded the direct antiviral in collaboration with Egyptian Health Insurance System.
Compliance with ethical standards
Conflict of interest
All authors declare no conflict of interest.
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