Effect of Chronic Kidney Disease Stage 3-5 on Hepatitis Therapy Outcome

Abstract

Introduction: Use of HCV DAA agents have resulted in significant improvement in the treatment outcomes in patients with chronic HCV. Certain patient subgroups such as patients with chronic kidney disease remain a challenge with SVR rates that are lower than the general HCV population. Limited data exists on factors that may effect treatment outcomes adversely in this population. The aim of this study was to describe the effect of CKD stage on HCV therapy outcome. Methods: Charts of a retrospective cohort of all patients with stage 3-5 CKD were reviewed. Data collected included demographics, HCV RNA, creatinine clearance, HCV genotype, liver fibrosis stage and co-morbidities. Results: A total of 15 patients were identified with an age range of 37 - 77 years. There were 13 males and 2 females with 10 Blacks, 2 Hispanics and 3 White patients. All patients were genotype 1 with liver fibrosis of stage 1-2 in 8 patients and stage 3-4 in 7 patients. CKD was stage 3 in 10 patients, stage 4 in 1 patient, stage 5 in 3 patients on hemodialysis and one stage 3 post kidney transplant patient. HCV therapy prescribed was elbasvir/grazoprevir in 6 patients, dasabuvir/ombitasvir/paritaprevir/ritonavir in 4 patients, ledipasvir/sofosbuvir in 3 patients, valpatasvir/sofosbuvir in 1 patient and simeprevir/sofosbuvir in 1 patient. All patients were HCV RNA not detected at week 4 and none relapsed during treatment. Treatment was discontinued between weeks 4-10 due to worsening kidney function in 4 patients which resulted in treatment failure. CKD in these treatment failure patients was stage 3 in 2 patients, stage 4 in 1 patient and 1 post kidney transplant patient. Overall the SVR rate was 80%; 67% in stage 3-4 CKD and 100% in Stage 5 CKD. Conclusion: Use of HCV DAA agents has resulted in a significant improvement in SVR rates in this difficult-to-treat population. Patients on hemodialysis are more likely to have better treatment outcomes as they are more stable medically and are easier to manage. Patients with CKD stage 3-4 are the most challenging during HCV therapy due to several factors including worsening of kidney function, poorly controlled blood pressure and diabetes resulting in premature discontinuation of therapy. Close monitoring of these patients is warranted and further studies are needed in order to identify CKD stage 3-4 patients that are likely to have improvement in their kidney function and in their quality of life as a result of HCV clearance.