Bouncing back or slowing down renal function decline after hepatitis C virus eradication

Hepatitis C virus (HCV) is both hepatotropic and lymphotropic in human bodies. Its cytopathic nature leads to a wide category of extrahepatic manifestations. The kidney one the target organs/systems that HCV involves. A poor renal function chronic hepatitis (CHC) patients may be due immune complex depositions causes glomerular or tubulointerstitial injuries. Increasing comorbidities than general population, such as diabetes, further compromise function. An early interferon-based cohort study Taiwan has shown antiviral treatment, regardless successful viral eradication, decrease risk end-stage disease (ESRD).1 It raised hope for possible halting reversal deteriorated CHC patients. In current issue by Su et al.,2 authors discussed short-term change estimated filtration rate (eGFR) who were treated with sofosbuvir/velpatasivir. One rationality safety concern sofosbuvir-based regimens stage 4 5 because overt accumulation delayed excretion metabolite, GS-331007. We now clearly know its use very safe whose eGFR was less 30 mL/min/1.73 m2 after approval FDA 2019. Among ESRD patients, GS-331007 smoothly removed regular hemodialysis, which never detected throughout 1 month year end sofosbuvir/velpatasivir treatment.3 did not show overall directly acting antivirals (DAAs) therapy. Rather, they observed an improvement baseline ≤60 but decreased >60 m2. This contradictory result difficult explain have been reported previous studies.4, should noted MDRD equation improperly judge healthy subject high level.6 Moreover, transient extremely levels shortly DAA indicate deterioration As declines aging, age per se would confounder comparison change. ideal way compare slope coefficient difference between comparators.4, 7, 8 Recently, Liu al. steeper decline failed therapy compared those achieved sustained virological response (SVR).9 Due lack control group (untreated treatment failure patients) era, another observe dynamic immediately before this study. To elucidate trend change, using repeat measurement multiple comparisons better statistic4 solely comparing delta parameter two time points treatment. Notably, binary categorization analysis lead misinterpretation. Actually, lower more room restoration if stratified subgroups based on their function.4 can imagine increase eGFR, there (delta eGFR) until certain turning point where starts pretreatment status. suggested eradication slow down speed decline.7 More importantly, we like see whether reduces ESRD. included 1987 receiving incidence SVR 0.06 100 person-years 0.37 non-SVR achievement significantly 76% ESRD.9 Nevertheless, larger nationwide including 12 696 (T-COACH) ones longer greater follow-up.10 index event, ESRD, studies rare. discrepant results part different patient characteristics. conclusion, benefit achieving preserving comes from direct removal complex. Indirectly, glycemic diabetic atherosclerosis, immune-medicated inflammation also play role protection eradication. being allocated possess factors confounders deterioration. net DAAs reducing opens window exploration. delcaim no conflicts interest.