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Abstract: FR-OR55

Renal Outcomes Associated with Direct Acting Antiviral Therapy in Patients with Hepatitis C Virus Infection

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Thomas, Fridtjof, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Potukuchi, Praveen Kumar, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Dashputre, Ankur A., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Molnar, Miklos Zsolt, University of Utah Health, Salt Lake City, Utah, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background

Direct Acting Antiviral (DAA) agents are effective treatments for chronic Hepatitis C virus (HCV) infection, leading to sustained viral response in the majority of treated individuals. While HCV infection is associated with poorer renal outcomes in observational studies, the effect of DAA therapy on long term renal outcomes remains unclear.

Methods

We identified a national cohort of US Veterans with HCV infection based on positive quantitative RNA viral load testing and extracted data on any DAA therapy using pharmacy dispensation data. We examined the association of DAA therapy (compared to no DAA therapy) with the incidence of end stage kidney disease (ESKD) and the composite of ESKD or death, using time dependent Cox models adjusted for demographic characteristics, socio-economic characteristics including alcohol and illicit substance use, comorbid conditions and baseline kidney function and proteinuria.

Results

We identified 114,358 patients with HCV infection, of whom 58,045 (51%) received a course of DAA therapy between 2013-2018. The overall mean (SD) age at HCV diagnosis was 55.0 (7.5) years, 97% were male, 38% were African American, the mean (SD) eGFR was 92 (17) ml/min/1.73 m2 and 8% had proteinuria. There were 497 ESKD events and 26,684 composite events over a median follow-up of 11.5 years. DAA therapy was associated with lower risk of ESKD and the composite event (multivariable adjusted HRs and 95%CI: 0.43, 0.31-0.61 and 0.62, 0.60-0.65) [table].

Conclusion

In a large national cohort of US veterans DAA therapy was associated with significantly lower risk of ESKD and the composite of ESKD or death, supporting the long term benefit on kidney function of HCV cure.

 N (%)ESKD event rateMultivariable adjusted hazard ratio (95% CI)ESKD or death event rateMultivariable adjusted hazard ratio (95% CI)
No DAA56,313 (49%)0.44/1000 PYReferent22.3/1000 PYReferent
DAA58,045 (51%)0.31/1000 PY0.43 (0.31-0.61)22.9/1000 PY0.62 (0.60-0.65)

Funding

  • Veterans Affairs Support