Direct-Acting Antiviral Therapy Improves Kidney Survival In Hepatitis C Virus-Associated Cryoglobulinaemia: The Renalcryoglobulinemic Study

Background. Direct-acting antiviral agents (DAAs) have shown high rates of sustained virological response in chronic hepatitis C virus (HCV) infection. However, the influence of DAAs on the course of kidney involvement in HCV-associated mixed cryoglobulinaemia (HCV-MC) has been little studied. The aim of this study was to analyse the effects of antiviral treatment on kidney prognosis and evolution in patients diagnosed with HCV-MC.Methods. The RENALCRYOGLOBULINEMIC study is an observational multicentre cohort study of 139 patients with HCV-MC from 14 Spanish centres. Clinical and laboratory parameters were measured before and after antiviral treatment. Primary endpoints were kidney survival and mortality after HCV-MC diagnosis. Secondary endpoints were clinical, immunological and virological responses after antiviral treatment.Results. Patients were divided into three groups based on the treatment received: treatment with DAAs (n=100) treatment with interferon (IFN) and ribavirin (RBV) (n=24) and no treatment (n=15). Patients were followed up for a median duration of 138 months (interquartile range 70-251. DAA treatment reduced overall mortality {hazard ratio [HR] 0.12 [95% confidence interval (CI) 0.04-0.40]; P<0.001} and improved kidney survival [HR 0.10 (95% CI 0.04-0.33); P<0.001].Conclusions. Results from the RENALCRYOGLOBULINEMIC study indicated that DAA treatment in patients with HCV-MC improves kidney survival and reduces mortality.