6 reports on comorbid renal outcomes in liver disease

Patients with liver disease, especially those with advanced liver disease, may face comorbid renal-related complications including impaired renal function and hepatorenal syndrome. Liver disease and kidney care have also been tied lately between use of hepatitis C-infected kidneys in nonviremic patients.

Healio Gastroenterology and Liver Disease presents the following reports on renal function in patients treated for hepatitis B and for pregnant women who underwent liver transplantation, a safety report on direct-acting antivirals for those with severe renal impairment, and predicting hepatorenal syndrome via acute-on-chronic liver failure.

TDF for HBV does not worsen renal function in most patients

Treatment with tenofovir disoproxil fumarate for chronic hepatitis B did not correlate with a higher risk for worsening of renal function among patients with significant renal impairment in a study that compared therapy outcomes with Baraclude.

“Our results suggest that for healthier patients, TDF and [Baraclude] are comparable [chronic HBV] treatment choices regarding renal safety,” Sam Trinh, BS, from Stanford University Medical Center in California, and colleagues wrote. “However, for those with moderate renal impairment or over 60 years old, renal outcomes with TDF may be worse while improvement can be expected for patients treated with [Baraclude].” READ MORE

Renal function predicts preterm birth in liver transplant recipients

Preconception renal function predicted preterm birth in pregnant women who underwent prior liver transplantation, according to a recently published study.

“Our results show that the number of live births is increasing in parallel to the number of women of reproductive age undergoing LT. Moreover, the live birth rate has also increased significantly over the last three decades,” Tiong Y. Lim, MD, from King's College Hospital, London, and colleagues wrote. “There are currently limited prognostic markers predicting outcomes in LT recipients wishing to get pregnant. We have shown ... that preconception renal function is a useful marker to prognosticate pregnancy outcomes in women following LT.” READ MORE

Findings support efficacy of kidneys from donors with hepatitis C virus for transplant

Researchers of a recently published study found kidneys from donors infected with the hepatitis C virus functioned similarly to kidneys from donors without the virus 1 year after transplant. Additionally, these kidneys are gaining greater acceptance from transplant centers and are increasingly transplanted into recipients without preexisting hepatitis C virus which, according to Peter P. Reese, MD, MSCE, of the University of Pennsylvania, is a “huge change from past practice.”

“The excellent function of these organs should be reassuring to patients and their doctors,” Reese told Healio/Nephrology. “Hepatitis C virus used to be a dreaded infection because treatment options were so bad. Now, direct-acting antiviral treatments have made this infection curable. The medical profession may have work to do to de-stigmatize hepatitis C virus so that patients waiting for transplant consider the option of these organs and sense the new optimism in the field about treatments for hepatitis C.” READ MORE

Gilead DAAs safe, effective for adults with HCV, severe renal impairment

The FDA approved changes to the product labels for direct-acting antivirals Harvoni, Epclusa, and Vosevi to include new efficacy and safety data for adults with hepatitis C and severe renal impairment, including those who require dialysis.

“The product labeling updates for Epclusa, Harvoni and Vosevi recognize the high unmet need for effective HCV treatments for patients with severe renal impairment, including those with end stage renal disease (ESRD) who are on dialysis,” Gilead said in a statement sent to Healio Gastroenterology and Liver Disease. “People with chronic HCV who are on dialysis as a result of ESRD have an increased risk of morbidity and mortality. Prior HCV treatment options for this population have been associated with clinical barriers resulting in continued unmet medical need, and these approvals provide important new options for these patients.” READ MORE

Terlipressin reverses hepatorenal syndrome in phase 3 trial

Initial results from a phase 3 clinical study of terlipressin showed that the therapy met its primary endpoint of “verified” hepatorenal syndrome type 1 reversal, according to a press release from Mallinckrodt.

“The initial results from the phase 3 CONFIRM study are very encouraging in that they demonstrate terlipressin reversed the course of [hepatorenal syndrome type 1 (HRS-1)] as measured by improvement in renal function, avoidance of dialysis and short-term survival,” Arun J. Sanyal, MD, from the Virginia Commonwealth University, said in the release. “We anticipate the complete results will continue to help inform the effectiveness and safety profile of terlipressin in this patient population with urgent unmet medical needs.” READ MORE

Acute-on-chronic liver failure grade predicts hepatorenal syndrome outcomes

Acute-on-chronic liver failure grade was a significant determinant of response to terlipressin and albumin among patients treated for type 1 hepatorenal syndrome, according to a recently published study.

“The most outstanding observation of our study is that severity of ACLF, as estimated by the number of extrarenal organ failures, is an additional important factor predicting treatment response in patients with [hepatorenal syndrome (HRS)],” Salvatore Piano, MD, from the University of Padova, Italy, and colleagues wrote. “These data as well as the effects of HRS reversal on survival may have important implications for clinical practice, in particular in patients with [ACLF grade 3].” READ MORE