Does elevation of serum creatinine in patients with chronic hepatitis C under therapy of telaprevir mean renal impairment?. (November 2015)

• Record Type: Journal Article
• Authors: Matsui, Katsuomi; Kamijo‐Ikemori, Atsuko; Sugaya, Takeshi; Ikeda, Hiroki; Okuse, Chiaki; Shibagaki, Yugo; Yasuda, Takashi; Kimura, Kenjiro
• Is Part Of: Nephrology. Volume 20:Number 11(2015)
• Page Start: 843
• Page End: 848
• Publication Date: 2015-11
• Subjects: chronic hepatitis C virus infection -- liver‐type fatty acid‐binding protein -- telaprevir -- acute kidney injury -- multidrug and toxin extrusion transporters; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.12517
• Languages: English
• ISSNs: 1320-5358

Abstract

Abstract: Aim: Treatment with telaprevir (TVR) entails adverse side‐effects including anaemia and elevation of serum creatinine (SCr) level. Our purpose was to evaluate the effects of treatment with TVR on renal function in adults with chronic hepatitis C. Methods: Thirteen adult patients with HCV genotype 1b who were scheduled to be treated with TVR, pegylated interferon (PEG IFN), and ribavirin (RBV) were prospectively followed. Patients were divided into two groups: (i) patients with an increase in SCr during the treatment ( n = 8), and (ii) patients without an increase in SCr ( n = 5). Urine and serum parameters were evaluated. Results: Although there was no difference in SCr level between the two groups before HCV therapy, the SCr level was persistently high in the patients in the increase‐in‐SCr group during the triple therapy. The SCr level returned to the pre‐treatment level after cessation of TVR. There were no differences in urinary L‐FABP, NAG, serum cystatin C level and eGFRcys throughout the study between the two groups. The serum cystatin C level at pre‐treatment tended to be higher in the increase‐in‐SCr group. Urinary L‐FABP and NAG levels in these groups remained within normal limits during treatment. We found that the increase in SCr was not associated with the degree of renal impairment. The increase in SCr may have been induced as a result of a decrease in creatinine secretion from proximal tubules via inhibition of transporters of creatinine induced by TVR. Conclusion: Elevation of SCr levels with TVR therapy may not suggest renal impairment. Summary at a Glance: This paper highlights that Telaprivar, a serine protease inhibitor, used to treat hepatitis C competes for the tubular secretion of creatinine producing an elevation in serum creatinine but no change in renal function. It is important to be aware of such competitive inhibtion of tubular transport by drugs before assuming that a particular drug has caused renal impairment.