Clinical journal of the American Society of Nephrology: CJASN | |
Effect of Sofosbuvir-Based Hepatitis C Virus Therapy on Kidney Function in Patients with CKD | |
Guillermo A. Ortiz2  Meghan E. Sise3  | |
[1] and..‖Division of Gastroenterology, Brigham and Women’s Hospital, Boston, Massachusetts..¶Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts;*Department of Medicine, Division of Nephrology,..*Department of Medicine, Division of Nephrology,..‡Department of Medicine, Gastrointestinal Unit, and..‡Department of Medicine, Gastrointestinal Unit, and..‡Department of Medicine, Gastrointestinal Unit, and..*Department of Medicine, Division of Nephrology,..§Division of Gastroenterology, University of Massachusetts Medical Center, Worcester, Massachusetts;*Department of Medicine, Division of Nephrology,..†Department of Pharmacy,..;*Department of Medicine, Division of Nephrology,..‡Department of Medicine, Gastrointestinal Unit, and.. | |
关键词: diabetes; virology; chronic kidney disease; drug nephrotoxicity; progression of renal failure; albuminuria; Antiviral Agents; creatinine; diabetes mellitus; Disease Progression; Follow-Up Studies; Genotype; glomerular filtration rate; Hepacivirus; Hepatitis C; Humans; Kidney Failure, Chronic; Liver; Cirrhosis; Male; Middle Aged; proteinuria; Renal Insufficiency, Chronic; Retrospective Studies; Sofosbuvir; Sustained Virologic Response; | |
DOI : 10.2215/CJN.02510317 | |
学科分类:泌尿医学 | |
来源: American Society of Nephrology | |
【 摘 要 】
Background and objectives Hepatitis C virus infection is common in patients with CKD and leads to accelerated progression to ESRD. Sofosbuvir is a potent direct-acting antiviral therapy against hepatitis C virus; however, there are concerns about its safety in patients with CKD. The objective of our study was to determine the safety and efficacy of sofosbuvir in patients with CKD.Design, setting, participants, & measurements We studied a retrospective observational cohort of patients with CKD defined by eGFR<60 ml/min per 1.73 m2, ≥30 mg albuminuria per 1 g creatinine, or ≥200 mg proteinuria per 1 g creatinine who received sofosbuvir-based therapy in a large health care system. Regression models were constructed to predict likelihood of sustained virologic response, detect adverse events, and examine changes in eGFR from baseline to follow-up.Results Ninety-eight patients with CKD (42% stage 1 or 2 CKD and 58% stage 3 CKD) were included. Mean age was 62 years old, 78% were men, and 65% were white. Additionally, 49% of patients had diabetes, 38% of patients had cirrhosis, and 33% of patients had prior solid organ transplant. Overall sustained virologic response was 81% and varied by regimen used and viral genotype. Average baseline eGFR was equivalent to average on-treatment eGFR, but seven patients experienced a rise in creatinine ≥1.5 times baseline while taking sofosbuvir; all but one recovered. In patients with eGFR<60 ml/min per 1.73 m2 at baseline (stage 3 CKD), regression models showed that hepatitis C cure was associated with a 9.3 (95% confidence interval, 0.44 to 18) ml/min per 1.73 m2 improvement in eGFR during the 6-month post-treatment follow-up period. Adverse events were common (81%), but serious adverse events (17%) and treatment discontinuations (8%) were uncommon.Conclusions Sofosbuvir-based direct-acting antiviral therapy is safe and effective in a cohort of patients with CKD infected with hepatitis C.
【 授权许可】
CC BY
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