Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Medicine Department, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
Gastroenterol Hepatol. 2023 Oct;46(8):594-602. doi: 10.1016/j.gastrohep.2022.12.004. Epub 2022 Dec 27.
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.
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.
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.
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.
患有慢性肾脏病（CKD）和丙型肝炎感染的患者可以安全有效地接受直接作用抗病毒药物（DAAs）治疗。然而，关于丙型肝炎治愈对 CKD 的长期影响的数据很少。本研究的目的是评估在接受 DAA 治疗的丙型肝炎感染合并 CKD 患者队列中，长期死亡率、发病率和肝/肾功能结局。
在一项多中心研究中，评估了 135 名 CKD 3b-5 期接受 ombitasvir/paritaprevir/ritonavir±dasabuvir 治疗的 HCV 患者的长期肝肾功能结局及其相关死亡率。
125 名患者获得 SVR，其中 66 名被纳入研究。在获得 SVR 之前，53 名患者接受肾脏替代治疗（RRT），25 名（37.8%）患有肝硬化。随访 4.5 年后，25 名（38%）需要进行肾移植，但没有联合肝-肾移植。虽然在未接受肾移植的 51 名患者中没有观察到肾功能变化，但 eGFR 值在基线 CKD 3b-4 期的患者中有所改善。3 名（5.6%）患者从 RRT 中脱机。18 名（27.3%）患者死亡，主要死于心血管事件；2 名患者发生肝功能失代偿，1 名患者发生肝细胞癌。未观察到 HCV 再感染。
尽管丙型肝炎治愈，但终末期 CKD 患者的长期死亡率仍然很高。总体而言，肾功能没有改善，很大一部分患者需要进行肾移植。然而，在 CKD 3b-4 期，丙型肝炎治愈可能对肾功能有积极作用。
