Direct-acting antiviral therapy correlates with lower risk of ESKD in patients with HCV
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When treated with direct-acting antiviral therapy, patients with chronic hepatitis C virus infection were at a lower risk for end-stage kidney disease and the composite of ESKD or death, according to a speaker at ASN Kidney week.
“The rationale for our study is that hepatitis C is known to be associated with increased incidences of chronic kidney disease and ESKD and progressive loss of kidney function in general,” Fridtjof Thomas, PhD, professor at the University of Tennessee Health Science Center, said. “Therefore, the question is whether direct-acting antiviral (DAA) therapy in hepatitis C patients reduces subsequent CKD and ESKD.”
After identifying a national cohort of U.S. veterans with HCV infection through viral load testing, researchers extracted data on any DAA therapy using pharmacy dispensation data. Researchers then investigated the correlation of DAA therapy (compared with no DAA therapy) with the occurrence of ESKD and the composite of ESKD or death using Cox models adjusted for demographic characteristics, socioeconomic characteristics, comorbid conditions, and baseline kidney function and proteinuria.
In total, 114,358 patients had HCV infection (mean age at HCV diagnosis, 55 years; mean eGFR, 92 mL/min/1.73 m2; 97% were men; 38% were African American; 8% had proteinuria) and 51% of them received a course of DAA therapy between 2014 and 2018. During a median follow-up of 11.5 years, there were 497 ESKD events and 26,684 composite events.
“The [DAA] therapy is associated with lower risk of end-stage renal disease and the composite outcome as well. This conclusion is based on DAA time-dependent covariate and the model that correctly limits exposure time for DAA therapy to the time after first initiation,” Thomas said.
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Thomas F, et al. Renal outcomes associated with direct-acting antiviral therapy in patients with hepatitis C virus infection. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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