Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Viral Hepat. 2021 May;28(5):755-763. doi: 10.1111/jvh.13484. Epub 2021 Feb 24.
Hepatitis C virus (HCV) infection can cause renal dysfunction, expected to improve upon HCV eradication. However, adverse effects of HCV eradication using direct-acting antiviral agents (DAAs) on renal function have been recently reported. This retrospective study aimed to evaluate renal function with glomerular filtration rate (eGFR) estimated using creatinine (eGFRcre) and cystatin C (eGFRcys). Complete clinical information and preserved serum samples were collected from 207 patients with HCV infection treated with interferon-free DAA at baseline and SVR48 (SVR48). Patients who underwent paired computed tomography (CT) at baseline and ≥12 months after DAA were evaluated for changes in skeletal muscle mass using the psoas muscle mass index (PMI). eGFRcre significantly worsened at SVR48, while eGFRcys was similar at baseline and SVR48. At baseline, eGFRcre was significantly higher than eGFRcys; eGFRcre and eGFRcys were similar at SVR48. Multivariate analysis revealed that the presence of liver cirrhosis and low-albumin level, as well as cirrhosis and age, was significantly associated with the overestimation of renal function by eGFRcre at baseline and SVR48, respectively. In the 57 patients who underwent paired CT at baseline and ≥12 months after DAA, relative values of PMI significantly increased after DAA. After DAA, in patients with increased PMI (65% 37/57), eGFRcre significantly worsened but did not change in patients without increased PMI. eGFRcre significantly worsened after DAAs; however, this might not reflect accurate changes in renal function, partially because of changes in skeletal muscle mass. eGFRcys did not change after DAAs, and it is a potential alternative to eGFRcre.
丙型肝炎病毒（HCV）感染可导致肾功能障碍，预计在 HCV 清除后可得到改善。然而，最近有报道称，直接作用抗病毒药物（DAA）清除 HCV 对肾功能有不良影响。本回顾性研究旨在评估肾小球滤过率（eGFR）的变化，eGFR 采用肌酐（eGFRcre）和胱抑素 C（eGFRcys）估算。在基线和 SVR48（SVR48）时，收集了 207 例接受无干扰素 DAA 治疗的 HCV 感染患者的完整临床信息和保存的血清样本。对基线和 DAA 治疗后≥12 个月行 CT 检查的患者，采用腰大肌肌肉质量指数（PMI）评估骨骼肌质量的变化。SVR48 时 eGFRcre 显著恶化，而 eGFRcys 在基线和 SVR48 时相似。基线时，eGFRcre 明显高于 eGFRcys；SVR48 时，eGFRcre 和 eGFRcys 相似。多变量分析显示，基线和 SVR48 时，存在肝硬化和低白蛋白血症，以及肝硬化和年龄与 eGFRcre 高估肾功能显著相关。在基线和 DAA 治疗后≥12 个月行 CT 检查的 57 例患者中，DAA 后 PMI 的相对值显著增加。在 DAA 后，在 PMI 增加（65%，37/57）的患者中，eGFRcre 显著恶化，但在 PMI 未增加的患者中没有变化。DAA 后 eGFRcre 显著恶化，但可能不能反映肾功能的准确变化，部分原因是骨骼肌质量的变化。DAA 后 eGFRcys 没有变化，是 eGFRcre 的潜在替代方法。
