Impact of Direct Acting Antiviral Agents on kidney function in Hepatitis C Virus infected patients with chronic kidney disease

Abstract

Introduction Despite the significant link between HCV and CKD progression, most of the patients with CKD infected with HCV remain untreated, because they have historically been difficult to treat due to common adverse effects associated with interferon (IFN), ribavirin, and first generation protease inhibitors. Recently, there have been major advancements in the treatment of HCV with the development of new directacting antivirals (DAAs). Objectives To evaluate the safety and efficacy of DAAs and their impact on kidney function in CKD patients. Patients and Methods We conducted a prospective observational study on 100 CKD patients stages 3-4, receiving treatment for HCV at MASRI (faculty of Medicine Ain Shams University Research Institute), with two different DAAs regimens, completed over six months follow up. Kidney function was followed during and after treatment. Results Sustained virological response (SVR) was achieved in all patients. AKI (acute kidney injury) was uncommon; it occurred in three (3%) patients, out of them, two patients showed complete recovery. Adverse events were common (43%), but serious adverse events were uncommon (2%).Improvement of eGFR (8-15 ml/min/1.73 m2) and proteinuria was found in both study groups. Conclusion DAAs were effective and welltolerated for HCV infected patients with stage 3-4 chronic kidney disease, where viral clearance caused improvement in eGFR and proteinuria.