Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan.
J Viral Hepat. 2019 Dec;26(12):1404-1412. doi: 10.1111/jvh.13193. Epub 2019 Oct 7.
Renal toxicity of direct-acting antivirals (DAAs) in chronic hepatitis C (CHC) patients has not been well-characterized. The aim of this study was to assess renal safety of DAAs in an Asian CHC patient cohort. Data from CHC patients (n = 1536) treated with DAAs were used in this retrospective study. Serial estimated glomerular filtration rate (eGFR) at pretreatment (1-year prior to treatment), baseline, end of treatment (EOT), and 12 weeks after treatment (SVR ) was evaluated. While a significant decrease in eGFR from baseline to EOT (84.8 → 81.8 mL/min/1.73 m , P < .001) was observed; subsequently, a slight rise at SVR (84.3 mL/min/1.73 m ) was also evident. Changes in eGFR after DAA treatment were similar to those seen in PrOD, DCV/ASV and GZP/EBV regimens, except in the SOF-based regimen wherein eGFR remained unchanged from EOT to SVR , especially in liver transplant recipients. Multivariate analysis revealed that age >65 years (OR = 1.862, P = .011), baseline eGFR ≥ 60 mL/min/1.73 m (OR = 2.684, P = .023), and liver transplant (OR = 3.894, P = .001) were independent risk factors for deteriorating renal function. In conclusion, DAA treatment led to a significant decline in eGFR at EOT but was followed by a slight rise at 12 weeks after treatment. A similar trend was observed with PrOD, DCV/ASV and GZP/EBV, but not in SOF-based regimens. As age >65 years, baseline eGFR ≥ 60 mL/min/1.73 m and liver transplantation are significant risk factors for deterioration in renal function, we strongly advice close monitoring of renal function in these populations.
直接作用抗病毒药物（DAAs）在慢性丙型肝炎（CHC）患者中的肾毒性尚未得到充分描述。本研究旨在评估亚洲 CHC 患者队列中 DAA 的肾脏安全性。这项回顾性研究使用了接受 DAA 治疗的 CHC 患者的数据（n=1536）。评估了治疗前（治疗前 1 年）、基线、治疗结束时（EOT）和治疗后 12 周（SVR）的连续估计肾小球滤过率（eGFR）。虽然从基线到 EOT 观察到 eGFR 显著下降（84.8→81.8 mL/min/1.73 m 2 ，P<.001）；随后，SVR 时也出现了轻微升高（84.3 mL/min/1.73 m 2 ）。DAA 治疗后 eGFR 的变化与 PrOD、DCV/ASV 和 GZP/EBV 方案相似，除了 SOF 方案外，EOT 至 SVR 期间 eGFR 保持不变，特别是在肝移植受者中。多变量分析显示，年龄>65 岁（OR=1.862，P=.011）、基线 eGFR≥60 mL/min/1.73 m 2 （OR=2.684，P=.023）和肝移植（OR=3.894，P=.001）是肾功能恶化的独立危险因素。总之，DAA 治疗在 EOT 时导致 eGFR 显著下降，但在治疗后 12 周时略有上升。与 PrOD、DCV/ASV 和 GZP/EBV 观察到的趋势相似，但 SOF 方案则不然。年龄>65 岁、基线 eGFR≥60 mL/min/1.73 m 2 和肝移植是肾功能恶化的重要危险因素，因此强烈建议在这些人群中密切监测肾功能。
