Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2017; 9(36): 1352-1360
Published online Dec 28, 2017. doi: 10.4254/wjh.v9.i36.1352
Impact of sustained virologic response on chronic kidney disease progression in hepatitis C
Elizabeth S Aby, Tien S Dong, Jenna Kawamoto, Joseph R Pisegna, Jihane N Benhammou
Elizabeth S Aby, Tien S Dong, Jenna Kawamoto, Joseph R Pisegna, Jihane N Benhammou, Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, United States
Elizabeth S Aby, Tien S Dong, Joseph R Pisegna, Jihane N Benhammou, the Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA Los Angeles, Department of Medicine, University of California David Geffen School of Medicine, Los Angeles, CA 90095, United States
Author contributions: Aby ES, Dong TS, Kawamoto J, Pisegna JR and Benhammou JN were involved in study concept and design; Aby ES and Dong TS were involved in data acquisition; Aby ES, Dong TS and Benhammou JN were involved in analysis and interpretation of data; Aby ES drafted the manuscript; Dong TS, Pisegna JR and Benhammou JN were involved in critical revision of the manuscript for important intellectual content; Dong TS performed the statistical analysis; Pisegna JR provided administrative, technical and material support as well as study supervision.
Supported by Department of Veterans Affairs RR and D Merit Review, No. I01 RX000194 (to Pisegna JR); Human Studies CORE through CURE: Digestive Diseases Research Center supported by NIH grant; Nos. P30DK41301 (to Pisegna JR) and NIH T32 DK07180-43 (to Benhammou JN).
Institutional review board statement: This study was approved by the VA Institutional Review Board and the Research and Development Committee at VA Greater Los Angeles Health System (VAGLAHS). Tracking Number 2016-100938.
Informed consent statement: Due to the retrospective nature of this study, an exempt for informed consent was approved by the VA institutional review board.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jihane N Benhammou, MD, the Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, 11301 Wilshire Blvd., Los Angeles, CA 90073, United States. jbenhammou@mednet.ucla.edu
Telephone: +1-310-2683131 Fax: +1-310-2684096
Received: October 6, 2017
Peer-review started: October 6, 2017
First decision: November 7, 2017
Revised: November 17, 2017
Accepted: December 5, 2017
Article in press: December 6, 2017
Published online: December 28, 2017
Processing time: 82 Days and 6.3 Hours
ARTICLE HIGHLIGHTS
Research background

Hepatitis C virus (HCV) is a significant public health issue in the United States and worldwide. The consequences of HCV infection extend beyond the liver, including renal complications. Patients with HCV are at risk for renal function decline and developing end-stage renal disease (ESRD). Chronic kidney disease (CKD) is an important public health problem as it increases the likelihood of adverse outcomes and is associated with high healthcare costs.

Research motivation

Given HCV infection places patients at risk for renal function decline and developing ESRD, it is valuable to understand how the clearance of HCV infection with interferon free, direct acting antiviral (DAA) therapy affects chronic kidney progression. Given the recent introduction of DAA therapy, the impact of HCV clearance on kidney disease has not been fully established.

Research objectives

The authors’ principal aim was to determine if the achievement of sustained virological response at 12 wk (SVR12) with interferon-free, DAAs impacts the progression of CKD.

Research methods

The authors retrospectively analyzed medical records of adult patients who initiated hepatitis C treatment with interferon-free DAAs from 2014 to 2016 at the VA Greater Los Angeles Healthcare System. The control group consisted of adult patients who did not undergo hepatitis C treatment, prior to the introduction of DAAs, from 2011 to 2013. Baseline demographic and clinical data were collected. The rate of change in estimated glomerular filtration rate (eGFR) one-year after HCV treatment compared to one-year before treatment was compared between patients who achieved SVR12 to those who did not. The change in eGFR was recorded over two years in patients who did not undergo treatment and compared to those who underwent DAA treatment.

Research results

The findings of the analysis suggest that patients who achieved SVR12 with interferon-free DAAs had a reduced progression of renal disease that was statistically significant compared to patients who did not achieve SVR12. However, there were no significant differences in renal function decline between patients who were not treated with DAAs compared to those who were treated and achieved SVR12. The control group was not statistically different from the cohort of HCV treated patients, except that the there were significantly more patients with cirrhosis and obesity in the cohort who underwent HCV treatment compared to the control group. The control group, however, had significantly more patients with hypertension and congestive heart failure compared to the cohort who underwent HCV treatment.

Research conclusions

There is a lesser decline in renal function in patients who achieved SVR12 compared to those who did not, however there were no significant differences in renal function decline between patients who were not treated compared to those who achieved SVR12. There are several possible explanations for the lack of improvement of CKD progression with viral eradication, such as immune factors related to cyroglobulins, intrinsic renal disease prior to therapy, and that the control group had significantly more patients with cirrhosis compared to the treatment group.

Research perspectives

Additional research is needed to confirm these results in multi-institutional studies with longer duration of follow-up.