Evolution of renal function under direct-acting antivirals treatment for chronic hepatitis C: A real-world experience

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 (SVR₁₂) was evaluated. While a significant decrease in eGFR from baseline to EOT (84.8 → 81.8 mL/min/1.73 m², P <.001) was observed; subsequently, a slight rise at SVR₁₂ (84.3 mL/min/1.73 m²) 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 SVR₁₂, especially in liver transplant recipients. Multivariate analysis revealed that age >65 years (OR = 1.862, P =.011), baseline eGFR ≥ 60 mL/min/1.73 m² (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 m² and liver transplantation are significant risk factors for deterioration in renal function, we strongly advice close monitoring of renal function in these populations.