2025 Southeastern Residency Conference

Title: Assessing Renal Function After Hepatitis C Treatment with a Pangenotypic Direct-Acting Antiviral: Sofosbuvir/Velpatasvir and Glecaprevir/Pibrentasvir

Authors: Chloe McGee, Charity Nora, Karli Nelson

Background: The 2023 American Association for the Study of Liver Diseases/Infectious Diseases Society of America (AASLD/IDSA) guidelines for the treatment of hepatitis C virus (HCV) recommend the use of pangenotypic direct acting antivirals (DAAs), such as sofosbuvir/velpatasvir (SOF/VEL) and glecaprevir/pibrentasvir (GLE/PIB), for all six major HCV genotypes. Treatment success is defined as undetectable HCV RNA levels at twelve weeks after treatment end, also known as sustained virologic response (SVR). In addition to impacting the liver, HCV has been associated with other negative effects including an increased risk of developing chronic kidney disease (CKD). While DAAs have been studied for safety and efficacy among patients with diagnosed CKD, there is a lack of data on the impact of HCV treatment with a pangenotypic DAA on renal function. The purpose of this study is to determine if successful treatment of HCV with a pangenotypic DAA leads to an improvement in renal function.

Methods: This was an IRB approved, observational, single center, retrospective chart review, which included adults eighteen years and older who achieved a twelve-week SVR after treatment of HCV with a pangenotypic DAA (GLE/PIB or SOF/VEL) between January 1, 2017 and January 1, 2024. Exclusions included non-compliance to the treatment regimen, history of kidney or liver transplant, end stage renal disease, or previous HCV treatment. The primary outcome was the change in serum creatinine from baseline to twelve-week SVR. Secondary endpoints included change in estimated glomerular filtration rate, percentage of patients achieving a 0.3 mg/dL or greater decrease in serum creatinine and change in chronic kidney disease classification. Data analysis to include descriptive statistics and paired t-tests as appropriate.

Results: A total of seventy-seven patients were included (44 in the SOF/VEL group and 30 in the GLE/PIB group). At baseline, over 90% of patients had an eGFR >60 ml/min/1.73m2. The median serum creatinine increased from 0.82 mg/dL at baseline to 0.88 mg/dL at 12 week SVR (p < 0.001). The median eGFR decreased from 95.5 mL/min/1.73 m2 to 88.0 mL/min/1.73 m2 at 12 week SVR (p < 0.001). 60% of patients did not have a change in their CKD eGFR category from baseline to 12 week SVR.

Conclusion: While a statistically significant worsening of renal function was detected, the clinical significance of a 0.6 mg/dL increase in serum creatinine is low. Additionally, when reviewing the change in CKD eGFR category, the majority of patients did not have a change in category. Based on these results, successful treatment of HCV with SOF/VEL or GLE/PIB did not result in a clinically significant change in renal function.