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Interferon-free regimens improve kidney function in patients with chronic hepatitis C infection

  • Nicola CoppolaEmail author
  • Federica Portunato
  • Antonio Riccardo Buonomo
  • Laura Staiano
  • Riccardo Scotto
  • Biagio Pinchera
  • Stefania De Pascalis
  • Daniela Caterina Amoruso
  • Salvatore Martini
  • Mariantonietta Pisaturo
  • Carmine Coppola
  • Ivan Gentile
Original Article
  • 34 Downloads

Abstract

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.

Results

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).

Conclusions

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.

Keywords

DAA Renal function CKD HCV infection eGFR 

Abbreviations

HCV

Hepatitis C virus

EHMs

Extra-hepatic manifestations

CKD

Chronic kidney disease (CKD)

ESRD

End-stage renal disease

SVR

Sustained virological response

DAAs

Directly acting antiviral agents

eGFR

Estimated glomerular filtration rate

HCC

Hepatocellular carcinoma

IFN

Interferon

CKD-EPI

Chronic Kidney Disease Epidemiology Collaboration

KDIGO

Kidney Disease Improving Global Outcome

1-MT

1-Month of therapy

EOT

End of treatment

12WPT

Week 12 after the end of treatment

IQR

Interquartile range

HR

Hazard ratio

95 CI

95% confidence interval

aHR

Adjusted hazard ratio

SOF

Sofosbuvir

LDV

Ledipasvir

RBV

Ribavirin

OMB

Ombitasvir

PAR

Paritaprevir

DAS

Dasabuvir

r

Ritonavir

Notes

Author contributions

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.

Funding

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.

Ethical statement

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

Informed consent was obtained from all participants included in the study.

Supplementary material

40620_2019_608_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 kb)

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Copyright information

© Italian Society of Nephrology 2019

Authors and Affiliations

  • Nicola Coppola
    • 1
    • 5
    Email author
  • Federica Portunato
    • 1
  • Antonio Riccardo Buonomo
    • 2
  • Laura Staiano
    • 3
  • Riccardo Scotto
    • 2
  • Biagio Pinchera
    • 2
  • Stefania De Pascalis
    • 1
  • Daniela Caterina Amoruso
    • 3
  • Salvatore Martini
    • 4
  • Mariantonietta Pisaturo
    • 1
  • Carmine Coppola
    • 3
  • Ivan Gentile
    • 2
  1. 1.Infectious Diseases Unit, Department of Mental Health and Public MedicineUniversity of Campania Luigi VanvitelliCasertaItaly
  2. 2.Section of Infectious Diseases, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
  3. 3.Unit of Hepatology and Interventional Ultrasonography, Department of Internal MedicineOORR Area Stabiese, Plesso Nuovo GragnanoNaplesItaly
  4. 4.HIV UnitUniversity of CampaniaNaplesItaly
  5. 5.Department of Mental and Public Health, Section of Infectious DiseasesUniversity of CamapaniaNaplesItaly

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