Abstract
The effectiveness and safety of direct-acting antiviral agents (DAAs) in hepatitis C virus (HCV) patients with renal insufficiency remain controversial. Therefore, this network meta-analysis aims to assess effectiveness and safety of DAAs in populations with different renal function. The pooled data were obtained from Cochrane Library, EMBASE, PubMed, and Web of Science. Thirteen studies recruited 6884 patients with hepatitis C infection and reported their outcomes in relation to different levels of renal function after treatment with DAAs. The results showed no difference in the virologic responses among patients with different renal function. Regarding safety, whereas in patients without chronic kidney disease (CKD) or with early CKD DAAs were associated with a risk ratio (RR) of 0.14 (95% confidence interval (CI), 0.04 to 0.43) for renal disorder, increased risk of renal function deterioration was found in advanced-CKD patients, though this effect may be related to the natural course of advanced CKD. Similarly, patients without CKD or with early CKD showed a lower risk of anemia (RR, 0.34; 95% CI, 0.20 to 0.57) and discontinuation (RR, 0.41; 95% CI, 0.39 to 0.56) than patients with advanced CKD. The efficacy of DAAs for HCV treatment was comparable in patients with advanced CKD and in those with early CKD or without CKD. However, the safety of DAAs should be verified in future studies.
Highlights
More than 170 million patients have chronic hepatitis C virus (HCV) infection worldwide, leading to 500,000 deaths annually [1]
In dialysis patients, the prevalence of HCV infection ranges from 2.6% to 22.9% [10], including in a US cohort showing that the prevalence of HCV-positivity in hemodialysis patients was 14.4%
The results showed similar virologic response at the end of treatment (VRET) rates between the two groups (RR, 0.99; 95% confidence intervals (95% CI), 0.96 to 1.02), with low to moderate heterogeneity (I2 = 31%, p = 0.21) (Figure 3b)
Summary
More than 170 million patients have chronic hepatitis C virus (HCV) infection worldwide, leading to 500,000 deaths annually [1]. HCV infection leads to increased risk of advanced CKD [7]. These patients face a higher risk of proteinuria and glomerulonephritis such as membranoproliferative glomerulonephritis or mixed cryoglobulinemia vasculitis [8,9]. In dialysis patients, the prevalence of HCV infection ranges from 2.6% to 22.9% [10], including in a US cohort showing that the prevalence of HCV-positivity in hemodialysis patients was 14.4%. This concomitant HCV infection is associated with an increased risk of all-cause and cardiovascular mortality in hemodialysis patients [11]
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