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Published on: October 1, 2015
Longitudinal effect of HCV cure on markers of kidney disease
Javier Cepeda1, Mohamed Atta2, Katie Zook2
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Insights
Curing chronic hepatitis C infection significantly improves kidney function, as measured by iohexol glomerular filtration rate (iGFR). Treatment attenuated kidney function decline, though it did not impact albuminuria levels.
Area of Science:
- Nephrology
- Hepatology
- Infectious Diseases
Background:
- Chronic hepatitis C (HCV) infection is associated with chronic kidney disease.
- Direct-acting antiviral (DAA) treatments offer a cure for HCV but their long-term impact on kidney function requires further evaluation.
- Iohexol glomerular filtration rate (iGFR) is a key marker for assessing kidney function.
Purpose of the Study:
- To evaluate the impact of HCV cure on kidney function, specifically iGFR, in a cohort of patients with chronic HCV infection.
- To assess the effect of HCV treatment on secondary outcomes like albuminuria.
Main Methods:
- A cohort of 208 participants with chronic HCV infection (63% co-infected with HIV) was enrolled across two recruitment periods.
- Linear mixed-effects modeling was used to analyze changes in iGFR slope between treated (cured) and untreated participants.
- Albuminuria was assessed as a secondary outcome using the urine albumin-creatinine ratio (uACR).
Main Results:
- HCV treatment was associated with a significantly higher iGFR slope (2.37 mL/min/1.73 m²/year) compared to untreated participants, indicating preserved kidney function.
- While iGFR declined overall, the rate of decline was attenuated in participants who were cured of HCV.
- HCV treatment status was not significantly associated with the probability of developing albuminuria.
Conclusions:
- Achieving HCV cure through antiviral treatment has a significant positive impact on preserving kidney function over time.
- HCV treatment may help attenuate the decline in kidney function observed in chronically infected individuals.
- Further research may explore the mechanisms behind HCV cure's protective effect on kidney function and its impact on albuminuria.
Abstract:
Chronic hepatitis C infection has been linked to chronic kidney disease. Despite availability of all oral highly curative direct acting antiviral treatment for more than a decade, impact of HCV cure on extrinsically measured iohexol glomerular filtration rate (iGFR), a marker of kidney function, has not been rigorously evaluated. Over two recruitment periods (October 14, 2010 - July 23, 2012 and December 15, 2015 - September 12, 2019), we enrolled 208 participants with chronic HCV infection, 63% of whom were co-infected with HIV. We conducted linear mixed effects modeling to evaluate the change in iGFR slope among participants who were and were not cured from chronic HCV. Secondary outcomes included albuminuria (urine albumin-creatinine-ratio ≥30 mg/g). At baseline, the median age was 51 years (interquartile range: 47-56), most of whom were Black (85%), and male (71%). In the multivariable-adjusted model, including baseline iGFR and other covariates, the adjust difference in iGFR slope was 2.37 mL/min/1.73 m2 per year (95% CI: 0.72, 4.03, p = 0.0051) higher among HCV treated participants compared to untreated. HCV treatment status was not associated with probability of albuminuria. Among participants chronically infected with HCV, we identified a significant positive impact of HCV cure on kidney function over time. While iGFR declined overall, declines were attenuated among participants treated for HCV compared to participants who remained untreated.
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