Evolution of renal function under direct-acting antivirals treatment for chronic hepatitis C: A real-world experience

Area of Science:

• Hepatology
• Nephrology
• Pharmacology

Background:

• The renal safety of direct-acting antivirals (DAAs) in chronic hepatitis C (CHC) patients requires further characterization.
• Understanding DAA-induced renal effects is crucial for patient management, especially in diverse populations.

Purpose of the Study:

• To evaluate the renal safety of DAAs in a large Asian cohort of CHC patients.
• To identify risk factors associated with renal function changes during and after DAA therapy.

Main Methods:

• A retrospective study involving 1536 CHC patients treated with DAAs.
• Serial assessment of estimated glomerular filtration rate (eGFR) at pre-treatment, baseline, end of treatment (EOT), and 12 weeks post-treatment (SVR12).
• Multivariate analysis to identify independent risk factors for renal function deterioration.

Main Results:

• A significant eGFR decrease was observed from baseline to EOT (84.8 to 81.8 mL/min/1.73 m²), followed by a slight recovery at SVR12 (84.3 mL/min/1.73 m²).
• Regimens like PrOD, DCV/ASV, and GZP/EBV showed similar eGFR trends, while SOF-based regimens maintained stable eGFR post-EOT, particularly in liver transplant recipients.
• Independent risk factors for renal function decline included age >65 years, baseline eGFR ≥60 mL/min/1.73 m², and liver transplantation.

Conclusions:

• DAA treatment induces a transient decline in renal function, with recovery observed 12 weeks post-treatment.
• Specific patient groups, including the elderly, those with higher baseline eGFR, and liver transplant recipients, require close renal function monitoring during DAA therapy.
• The findings highlight the importance of individualized monitoring strategies for renal safety in CHC patients undergoing DAA treatment.