Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy
Gastroenterol Hepatol. 2023 Oct;46(8):594-602.
doi: 10.1016/j.gastrohep.2022.12.004.
Epub 2022 Dec 27.
[Article in
English,
Spanish]
Authors
Joan Martínez-Campreciós
1
, Mar Riveiro-Barciela
2
, Raquel Muñoz-Gómez
3
, María-Carlota Londoño
4
, Mercé Roget
5
, Miguel Ángel Serra
6
, Desamparados Escudero-García
6
, Laura Purchades
6
, Manuel Rodríguez
7
, Juan E Losa-García
8
, María L Gutiérrez
9
, Isabel Carmona
10
, Javier García-Samaniego
11
, Luís Morano
12
, Ignacio Martín-Granizo
13
, Marta Montero-Alonso
14
, Martín Prieto
15
, Manuel Delgado
16
, Natalia Ramos
17
, María A Azancot
17
, Francisco Rodríguez-Frías
18
, Maria Buti
19
Affiliations
- 1 Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain.
- 2 Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain. Electronic address: mar.riveiro@gmail.com.
- 3 Department of Gastroenterology, Hospital General Universitario 12 de Octubre, Madrid, Spain.
- 4 CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Clínic/IDIBAPS, Barcelona, Spain.
- 5 Liver Unit, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain.
- 6 Digestive Medicine Service, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, Spain.
- 7 Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
- 8 Infectious Diseases Unit, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
- 9 Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
- 10 Digestive Disease Unit, Hospital Universitario Virgen Macarena, Seville, Spain.
- 11 CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario La Paz/IdiPaz, Madrid, Madrid, Spain.
- 12 Infectious Disease Unit, Internal Medicine Department, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; RIS (Red Española de Investigación en SIDA), Madrid, Spain.
- 13 Department of Gastroenterology, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
- 14 Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
- 15 CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Transplantation and Hepatology Unit, Hospital Universitari I Politècnic La Fe-IIS, La Fe, Valencia, Spain.
- 16 Digestive Disease Unit, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
- 17 Department of Nephrology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
- 18 Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain; Liver Pathology Lab, Biochemistry and Microbiology Departments (Clinical Laboratories), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
- 19 Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
Abstract
Background and aim:
Patients with chronic kidney disease (CKD) and hepatitis C infection can be safely and effectively treated with direct-acting antivirals (DAAs). However, there is scarce data on the long-term impact of hepatitis C cure on CKD. The aim of this study was to assess the long-term mortality, morbidity and hepatic/renal function outcomes in a cohort of HCV-infected individuals with CKD treated with DAAs.
Methods:
135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study were evaluated for long-term hepatic and renal outcomes and their associated mortality.
Results:
125 patients achieved SVR and 66 were included. Prior to SVR, 53 were under renal replacement therapy (RRT) and 25 (37.8%) had liver cirrhosis. After a follow-up of 4.5 years, 25 (38%) required kidney transplantation but none combined liver-kidney. No changes in renal function were observed among the 51 patients who did not receive renal transplant although eGFR values improved in those with baseline CKD stage 3b-4. Three (5.6%) subjects were weaned from RRT. Eighteen (27.3%) patients died, mostly from cardiovascular events; 2 developed liver decompensation and 1 hepatocellular carcinoma. No HCV reinfection was observed.
Conclusions:
Long-term mortality remained high among end-stage CKD patients despite HCV cure. Overall, no improvement in renal function was observed and a high proportion of patients required kidney transplantation. However, in CKD stage 3b-4 HCV cure may play a positive role in renal function.
Keywords:
Antivirales de acción directa; Chronic kidney disease; Direct-acting antivirals; Enfermedad renal crónica; Hepatitis C; Kidney transplantation; Trasplante renal.
Copyright © 2022 Elsevier España, S.L.U. All rights reserved.
MeSH terms
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Antiviral Agents / adverse effects
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Drug Therapy, Combination
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Follow-Up Studies
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Genotype
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Hepacivirus
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Hepatitis C* / drug therapy
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Hepatitis C, Chronic* / complications
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Hepatitis C, Chronic* / drug therapy
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Humans
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Kidney Failure, Chronic*
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Renal Insufficiency, Chronic* / complications