Neutrophil gelatinase-associated lipocalin partly reflects the dynamic changes of renal function among chronic hepatitis C patients receiving direct-acting antivirals.

Chi-Che Lee,Chen-Hao Li,Chen-Hua Liu,Yen-Chun Chen,Ru-Jiang Syu,Kuo-Chih Tseng,Ping-Hung Ko,Chih-Wei Tseng

doi:10.1371/journal.pone.0256505

Chi-Che Lee, Chen-Hao Li + Show 6 more

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https://doi.org/10.1371/journal.pone.0256505

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Journal: PloS one	Publication Date: Aug 26, 2021
License type: CC BY 4.0

Affiliation: Taipei Tzu Chi Hospital, Tzu Chi University

Abstract

Changes in renal function in chronic hepatitis C (CHC) patients receiving direct-acting antivirals (DAAs) are controversial. The evolution of neutrophil gelatinase-associated lipocalin (NGAL) in these patients remains unclear. A total of 232 CHC patients receiving DAA at Dalin Tzu Chi Hospital from May 2016 to February 2019, were enrolled in this retrospective study. Grade 2/3 renal function deterioration, defined as a decrease in eGFR between 10% and 50% from baseline (BL) to 12 weeks after the end of treatment (P12), was investigated for its association with BL characteristics. The changes in renal function and NGAL levels were also analyzed at the SOF-base or nonSOF-base DAA. Sixty-two patients (26.7%) had grade 2/3 renal function deterioration at P12 after DAA therapy. Univariate analysis showed that it was associated with age (P = 0.038). Multivariate analysis indicated that age (OR = 1.033, 95% CI: 1.004-1.064, P = 0.027), sex (male; OR = 2.039, 95% CI: 1.093-3.804, P = 0.025), ACEI/ARB use (OR = 2.493, 95% CI: 1.016-6.119, P = 0.046), and BL NGAL (OR = 1.033, 95% CI: 1.001-1.067, P = 0.046) positively correlated with grade 2/3 renal function deterioration. Furthermore, eGFR was decreased (P = 0.009) and NGAL was increased (P = 0.004) from BL to P12 in CHC patients receiving SOF-based DAA. Of the CHC patients receiving DAA therapy, 26.7% had grade 2/3 renal function deterioration at P12, and it was associated with older age, gender being male, ACEI/ARB use, and higher BL NGAL levels. In addition, NGAL might be a biomarker of nephrotoxicity at P12 in patients receiving SOF-based DAA.

Highlights

Chronic hepatitis C virus (HCV) infection may result in chronic kidney disease (CKD) and end-stage renal disease (ESRD) [1]
Multivariate analysis indicated that age (OR = 1.033, 95% CI: 1.004–1.064, P = 0.027), sex, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) use (OR = 2.493, 95% CI: 1.016– 6.119, P = 0.046), and BL neutrophil gelatinase-associated lipocalin (NGAL) (OR = 1.033, 95% CI: 1.001–1.067, P = 0.046) positively correlated with grade 2/3 renal function deterioration
Of the chronic hepatitis C (CHC) patients receiving direct-acting antivirals (DAA) therapy, 26.7% had grade 2/3 renal function deterioration at 12 weeks after end of treatment (P12), and it was associated with older age, gender being male, ACEI/ARB use, and higher BL NGAL levels

Summary

Introduction

Chronic hepatitis C virus (HCV) infection may result in chronic kidney disease (CKD) and end-stage renal disease (ESRD) [1]. Interferon-free direct-acting antivirals (DAAs) are the standard therapy for chronic hepatitis C (CHC) [2–4] and can improve some HCVrelated extrahepatic outcomes [1]. The short-term effect of DAA on renal function is inconclusive [5,6]. Several studies have reported that the estimated glomerular filtration rate (eGFR) might be reduced during DAA therapy, especially sofosbuvir (SOF) -based regimens [7–13]. Some studies have revealed that the eGFR change might be nonsignificant [10,11,13–16]. The metabolite of SOF is mainly cleared from the body via the kidney, but other kinds of DAAs are primarily metabolized and cleared by the liver [1], SOF-based DAA could be nephrotoxic. Changes in renal function in chronic hepatitis C (CHC) patients receiving direct-acting antivirals (DAAs) are controversial. The evolution of neutrophil gelatinase-associated lipocalin (NGAL) in these patients remains unclear

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