Impact of Sofosbuvir-Based Direct-Acting Antivirals on Renal Function in Chronic Hepatitis C Patients With Impaired Renal Function: A Large Cohort Study From the Nationwide HCV Registry Program (TACR)

Background & Aims: Sofosbuvir is approved for chronic hepatitis C (CHC) patients with severe chronic kidney disease (CKD). The impact of sofosbuvir-based therapy on renal function augmentation on a real-world nationwide basis is elusive. Methods: The 12,995 CHC patients treated with sofosbuvir-based (n = 6802) or non–sofosbuvir-based (n = 6193) regimens were retrieved from the Taiwan nationwide real-world HCV Registry Program. Serial estimated glomerular filtration rate (eGFR) levels were measured at baseline, end of treatment (EOT), and end of follow-up (EOF) (3 months after EOT). Results: The eGFR decreased from baseline (91.4 mL/min/1.73 m²) to EOT (88.4 mL/min/1.73 m²; P <.001) and substantially recovered at EOF (88.8 mL/min/1.73 m²) but did not return to pretreatment levels (P <.001). Notably, a significant decrease in eGFR was observed only in patients with baseline eGFR ≥90 mL/min/1.73 m² (from 112.9 to 106.4 mL/min/1.73 m²; P <.001). In contrast, eGFR increased progressively in patients whose baseline eGFR was <90 mL/min/1.73 m² (from 70.0 to 71.5 mL/min/1.73 m²; P <.001), and this increase was generalized across different stages of CKD. The trend of eGFR amelioration was consistent irrespective of sofosbuvir usage. Multivariate adjusted analysis demonstrated that baseline eGFR >90 mL/min/1.73 m² was the only factor independently associated with significant slope coefficient differences of eGFR (–1.98 mL/min/1.73 m²; 95% confidence interval, –2.24 to –1.72; P <.001). The use of sofosbuvir was not an independent factor associated with eGFR change. Conclusions: Both sofosbuvir and non–sofosbuvir-based regimens restored renal function in CHC patients with CKD, especially in those with significant renal function impairment.