Long-term follow-up of HCV-infected patients with end-stage chronic kidney disease after sustained virological response with direct-acting antiviral therapy

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.

Comments：

This study aimed to assess the long-term outcomes of HCV-infected individuals with CKD treated with DAAs. The study evaluated 135 HCV patients with CKD stage 3b-5 who received ombitasvir/paritaprevir/ritonavir±dasabuvir in a multicenter study. Of these, 125 patients achieved SVR, and 66 were included in the study. Prior to SVR, 53 were under renal replacement therapy (RRT), and 25 had liver cirrhosis.

After a follow-up of 4.5 years, 25 patients 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 subjects were weaned from RRT. Eighteen patients died, mostly from cardiovascular events. Two developed liver decompensation, and one developed hepatocellular carcinoma. No HCV reinfection was observed.

The study found that 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.

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