Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection
<h4>Background</h4> Direct-acting antivirals (DAA) are highly effective at treating Hepatitis C virus (HCV) infection, with a cure rate >95%. However, the effect of DAAs on kidney function remains debated. <h4>Methods</h4> We analyzed electronic health record data for DAA-...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9106151/?tool=EBI |
| _version_ | 1811235254320496640 |
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| author | Adrienne O’Donnell Nathan Pham Leandra Battisti Rachel Epstein David Nunes Deirdre Sawinski Sara Lodi |
| author_facet | Adrienne O’Donnell Nathan Pham Leandra Battisti Rachel Epstein David Nunes Deirdre Sawinski Sara Lodi |
| author_sort | Adrienne O’Donnell |
| collection | DOAJ |
| description | <h4>Background</h4> Direct-acting antivirals (DAA) are highly effective at treating Hepatitis C virus (HCV) infection, with a cure rate >95%. However, the effect of DAAs on kidney function remains debated. <h4>Methods</h4> We analyzed electronic health record data for DAA-naive patients with chronic HCV infection engaged in HCV care at Boston Medical Center between 2014 and 2018. We compared the following hypothetical interventions using causal inference methods: 1) initiation of DAA and 2) no DAA initiation. For patients with normal kidney function at baseline (eGFR>90 ml/min/1.73m2), we estimated and compared the risk for reaching Stage 3 chronic kidney disease (CKD) (eGFR≤60 ml/min/1.73m2) under each intervention. For patients with baseline CKD Stages 2–4 (15<eGFR≤90 ml/min/1.73m2), we estimated and compared the mean change in eGFR at 2 years after baseline under each intervention. We used the parametric g-formula to adjust our estimates for baseline and time-varying confounders. <h4>Results</h4> First, among 1390 patients with normal kidney function at baseline the estimated 2-year risk difference (95% CI) of reaching Stage 3 CKD for DAA initiation versus no DAA was -1% (-3, 2). Second, among 733 patients with CKD Stage 2–4 at baseline the estimated 2-year mean difference in change in eGFR for DAA initiation versus no DAA therapy was -3 ml/min/1.73m2 (-8, 2). <h4>Conclusions</h4> We found no effect of DAA initiation on kidney function, independent of baseline renal status. This suggests that DAAs may not be nephrotoxic; furthermore, in the short-term, HCV clearance may not improve CKD. |
| first_indexed | 2024-04-12T11:49:08Z |
| format | Article |
| id | doaj.art-234b639a146a41fc9cd1aaf14d6188b9 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T11:49:08Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-234b639a146a41fc9cd1aaf14d6188b92022-12-22T03:34:15ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01175Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infectionAdrienne O’DonnellNathan PhamLeandra BattistiRachel EpsteinDavid NunesDeirdre SawinskiSara Lodi<h4>Background</h4> Direct-acting antivirals (DAA) are highly effective at treating Hepatitis C virus (HCV) infection, with a cure rate >95%. However, the effect of DAAs on kidney function remains debated. <h4>Methods</h4> We analyzed electronic health record data for DAA-naive patients with chronic HCV infection engaged in HCV care at Boston Medical Center between 2014 and 2018. We compared the following hypothetical interventions using causal inference methods: 1) initiation of DAA and 2) no DAA initiation. For patients with normal kidney function at baseline (eGFR>90 ml/min/1.73m2), we estimated and compared the risk for reaching Stage 3 chronic kidney disease (CKD) (eGFR≤60 ml/min/1.73m2) under each intervention. For patients with baseline CKD Stages 2–4 (15<eGFR≤90 ml/min/1.73m2), we estimated and compared the mean change in eGFR at 2 years after baseline under each intervention. We used the parametric g-formula to adjust our estimates for baseline and time-varying confounders. <h4>Results</h4> First, among 1390 patients with normal kidney function at baseline the estimated 2-year risk difference (95% CI) of reaching Stage 3 CKD for DAA initiation versus no DAA was -1% (-3, 2). Second, among 733 patients with CKD Stage 2–4 at baseline the estimated 2-year mean difference in change in eGFR for DAA initiation versus no DAA therapy was -3 ml/min/1.73m2 (-8, 2). <h4>Conclusions</h4> We found no effect of DAA initiation on kidney function, independent of baseline renal status. This suggests that DAAs may not be nephrotoxic; furthermore, in the short-term, HCV clearance may not improve CKD.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9106151/?tool=EBI |
| spellingShingle | Adrienne O’Donnell Nathan Pham Leandra Battisti Rachel Epstein David Nunes Deirdre Sawinski Sara Lodi Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection PLoS ONE |
| title | Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection |
| title_full | Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection |
| title_fullStr | Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection |
| title_full_unstemmed | Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection |
| title_short | Estimating the causal effect of treatment with direct-acting antivirals on kidney function among individuals with hepatitis C virus infection |
| title_sort | estimating the causal effect of treatment with direct acting antivirals on kidney function among individuals with hepatitis c virus infection |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9106151/?tool=EBI |
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