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The effect of anemia on the efficacy and safety of treating chronic hepatitis C infection with direct-acting antivirals in patients with chronic kidney disease

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Abstract

Background/Aim

Chronic hepatitis-C infection is a great health burden in Egypt. The effect of anemia on the efficacy and safety of direct-acting anti-viral (DAA) therapies for those with chronic-kidney disease (CKD) has not been evaluated.

Patients/Methods

This single-center retrospective study included 235 renal patients: i.e., 70-CKD patients not on hemodialysis (42 with anemia, 28 without); 40 hemodialysis patients (16 anemic; 24 non-anemic), and 125 kidney-transplant (KTx) recipients (40 anemic; 85 non-anemic). Anemia was defined by a hemoglobin level < 10.5 g/dL. Hemodialysis patients received ritonavir-boosted paritaprevir/ombitasvir. KTx patients received sofosbuvir/daclatasvir. CKD patients with eGFR > 30 mL/min/1.73 m2 received sofosbuvir/daclatasvir. Those with eGFR < 30 mL/min/1.73 m2 received ritonavir-boosted paritaprevir/ombitasvir; 64 non-anemic patients also received ribavirin therapy.

Results

Mean age of CKDs was 49.1 years, 43.2 years for HDs, and 45.2 years for KTx patients. Most were male; body-mass index was ~ 23.8. Anemia did not affect the efficacy of DAAs in hemodialysis, CKD, or KTx patients. Most patients achieved a rapid virologic response (RVR), and a 12- and 24-week sustained viral response. Worsening of anemia among the non-anemic group was mostly related to ribavirin therapy in hemodialysis patients (11/16 patients). Acute kidney injury in CKDs occurred more frequently within the anemic group (59.5%) compared to the non-anemic group (32.1%). For KTx, graft impairment was more common among the anemic group (7/40) compared to the non-anemic group (2/85).

Conclusion

Hemoglobin levels of < 10.5 g/dL prior to DAA treatment did not affect the virological response in renal patients but was associated with increased serum creatinine among KTx and those with CKD.

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Acknowledgements

HCV working group (Urology and Nephrology teams), Egyptian Liver Research Institute team and Egyptian Medical insurance system for supplying the DAAs.

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Not funded.

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Author notes

  1. Lionel Rostaing and Mohamed Adel Bakr contributed equally to this manuscript.

Authors and Affiliations

  1. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Ahmed Yahia Elmowafy, Mohamed Hamed Abbas, Ahmed Abdelfattah Denewar, Mohamed Elsayed Mashaly, Salwa Mahmoud El Wasif & Mohamed Adel Bakr

  2. Egyptian Liver Research Institute and Hospital, Mansoura, Egypt

    Gamal Shiha

  3. Université Grenoble Alpes, Grenoble, France

    Lionel Rostaing

  4. Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation Rénale, CHU Grenoble-Alpes, CS 10217, 38043, Grenoble Cedex 09, France

    Lionel Rostaing

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  1. Ahmed Yahia Elmowafy
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Elmowafy, A.Y., Abbas, M.H., Denewar, A.A. et al. The effect of anemia on the efficacy and safety of treating chronic hepatitis C infection with direct-acting antivirals in patients with chronic kidney disease. Int Urol Nephrol 53, 749–761 (2021). https://doi.org/10.1007/s11255-020-02656-y

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