Study of the incidence of acute kidney injury in HCV infected patients receiving DAAs
Authors: Aref H M , Abdelaziz H E , Ahmed M S , Rezk S F 
Published: May 2020

Abstract

Background
Egypt had the highest burden of hepatitis C virus infection worldwide with genotype 4. The new direct-acting antivirals DAAs can target almost all steps of the HCV life cycle. The objective of our study was to detect AKI events during and on follow up after the end of treatment with combination DAAs.

Aim of the work
to study the incidence of acute kidney injury in HCV infected patients receiving IFN-free combination new DAAs.

Patients and Methods
A longitudinal prospective study that was conducted in the virology clinic in Kobry El-Koba Military Armed Forces Hospital on 63 male patients (&gt;18years) who are HCV antibody and PCR positive, treatment-naïve, who received treatment with sofosbuvir, daclatasvir and ribavirin. They were divided into Group A: 33 patients with normal kidney functions stage I and Group B: 30 patients with chronic kidney disease (CKD) with estimated GFR (eGFR) &gt;30 mL/min and &lt; 90 mL/min stage II, III. The fluctuations in serum creatinine and eGFR were measured while on-therapy and for 3 months follow up after end of treatment.

Results
Sixty three male patients, treatment-naive were included. Thirty of them had eGFR of less than 90 mL/min/1.73 m2 (25 with eGFR = 60-89 mL/min) & (5 with eGFR = 45-59 mL/min) of mean age 62.4 ± 7.4. These were compared to thirty-three patients with eGFR of more than 90 mL/min/1.73 m2 of mean age 53.8 ± 11 (P = 0.001). Our included treatment regimen was daclatasvir/sofosbuvir/RBV. A total of 54% had liver cirrhosis, 62/63 (98.5%) of the patients achieved SVR at 12th week; One CKD stage II patient continued treatment for 6 months because he had a detectable HCV RNA after 1st month of starting treatment. All other patients completed the treatment for 3 months. There is a statistical difference between different readings of serum creatinine in both groups on therapy and on follow up during the next 3 months after the end of therapy with a P value of 0.001 in group A and a P value of 0.005 in group B. There is a rise in serum creatinine in group A during the three months of therapy with slight improvement during follow up after the end of therapy without reaching the baseline. In group B it was noticed that there is slight increase in serum creatinine after 1st month of start of therapy then there is significant improvement after 3rd and 4th months of start of therapy to come to a plateau by the end of 6th month. The incidence of AKI was more observed in patients with eGFR &gt; 90 ml/min per 1.73 m2 by being 13.65% by the end of treatment but decreases to 6.1% by the end of the three months follow up after the end of treatment. This was compared to 3.3% in those with eGFR &lt; 90 ml/min per 1.73 m2 and &gt;45 ml/min per 1.73 m2 that was the same all through the follow up, but of no statistical significant difference.

Conclusion
daclatasvir/sofosbuvir/ribavirin antiviral therapy is effective in patients with stage 1-3 CKD with SVR of 98.5%. Although adverse effects are common, serious adverse effects and treatment discontinuations are rare. There were AKI events during and after the end of therapy especially in patients with normal baseline serum creatinine by 12.76% in comparison to 3.3% in already CKD patients stage 2 and 3. Patients with CKD stage 2 and 3 experienced improvement in their kidney functions during and after end of therapy . Future studies are needed to determine predictors of kidney recovery with HCV eradication and confirm the long-term effects of HCV eradication on kidney function.