Patients with hepatitis C (HCV) and advanced chronic kidney disease (CKD) are less likely to receive treatment for their viral infection than patients with less-advanced CKD and HCV, according to a study published in Liver International.
Using the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) dataset, investigators obtained data from people who were HCV positive and had CKD who were evaluated between October 1999 and July 2016 (N=83,706). In this cohort, investigators included patients who were receiving any direct-acting antiviral agent (DAA) and subdivided patients based on stage of CKD.
Among the patients included in this analysis, 21.1% initiated treatment for HCV. A greater proportion of patients with baseline estimated glomerular filtration rate >90 mL/min/1.73 m2 and CKD stage 2 had initiated treatment (22.1%) vs those in CKD stage 3 (14.9%) and CKD stages 4 and 5 (8.0%). The most commonly used treatment regimen consisted of sofosbuvir/ledipasvir (56.8%) compared with paritaprevir/ritonavir/ombitasvir/dasabuvir + ribavirin (11.5%). Patients in CKD stage 3 and CKD stage 4/5 were 33% and 60%, respectively, less likely to receive DAA treatment than those with estimated glomerular filtration rate >90 mL/min/1.73 m2.
Additionally, those with the HCV genotype 2 (odds ratio [OR] 0.59; 95% CI, 0.53-0.66) or 3 (OR 0.53; 95% CI, 0.47-0.61) were less likely to undergo treatment. In addition, patients with alcohol abuse or dependence (OR 0.74; 95% CI, 0.70-0.79), cardiovascular disease (OR 0.77; 95% CI, 0.70-0.84), cirrhosis (OR 0.86; 95% CI, 0.80-0.92), and diabetes (OR 0.87; 95% CI, 0.81-0.94) were also less likely to initiate treatment for HCV.
Considering patient data were obtained from electronic medical records and not through a more rigorous, blinded fashion in a clinical trial, the findings from this analysis are limited by potential bias. Additionally, treatment was defined as a prescription for HCV and did not necessarily mean the patient was taking the medication as prescribed.
Because newer DAA regimens are better tolerated and “safer and far more efficacious than the interferon/ribavirin regimen, there is a significant opportunity to increase treatment rates in this population.”
Butt AA, Ren Y, Puenpatom A, Arduino JM, Kumar R, Abou-Samra AB. HCV treatment initiation in persons with chronic kidney disease in the directly acting antiviral agents era: results from ERCHIVES [published online December 22, 2017]. Liver Int. doi: 10.1111/liv.13672