Evaluation of long-term outcomes of direct acting antiviral agents in chronic kidney disease subjects: a single center cohort study.
Abstract: Background: Chronic kidney disease (CKD) population, including kidney transplant recipients (KTRs) and subjects on renal replacement therapy, is particularly vulnerable to unfa-vorable outcomes of chronic hepatitis C (CHC). Currently, there are oral direct- acting antiviral agents (DAAs) available to eradicate the virus with favorable short-terms outcomes, however long-term effects are lacking. The aim of the study was to assess long-term efficacy and safety of DAA therapy in CKD population. Methods: An observational, cohort single-center study was performed. Fifty-nine CHC subjects with CKD, treated with DAAs between 2016 and 2018 were enrolled to the study. Safety and efficacy profiles were assessed, including sustained virologic response (SVR), occult hepatitis C infection (OCI) incidence and liver fibrosis. Results: SVR was achieved in 96 % of cases (n=57). OCI was diagnosed only in one subject following SVR. Signifi-cant Liver stiffness regression has been observed 4 years following SVR compered to baseline values (Mdn = 6.1 kPa, IQR = 3.75 kPa; 4.9 kPa,IQR = 2.9 kPa), p <0.001. Most common adverse events were anemia, weakness and urinary tract infection. Conclusion: DAAs provide a safe and effective cure for CHC in both CKD patients and KTRs with favorable safety profile in the long-term follow-up.