Anti-Tuberculous Treatment Effective in Patients with Chronic Kidney Disease

SAN DIEGO, CA— Response to anti-tuberculous treatment in patients with chronic kidney disease (CKD) was effective, although not as robust as seen in patients with normal glomerular filtration rate (GFR), noted Teny Mathew John, MD, DNB, from Hamad General Hospital, Doha, Qatar, India, at IDWeek 2012.

Tuberculosis is the most common infectious cause of mortality across the world. Chronic kidney disease is associated with increased risk of infections, especially tuberculosis. The efficacy and dosing of antituberculous treatment in patients with CKD has not been studied in much detail.

Dr. John and colleagues conducted a prospective study from August 2008–July 2010. Patients with CKD and a diagnosis of tuberculosis (n=572) were started on antituberculous treatment using isoniazid (5mg/kg daily), rifampicin (10mg/kg daily), pyrazinamide (12–20mg/kg every other day), ethambutol (15–25mg/kg every other day) and/or ofloxacin (400mg every other day). Doses were adjusted according to GFR. Extra-pulmonary tuberculosis was the predominant form (84.8%), of which pleural effusion tuberculosis (32.1%) was the most common. The tuberculosis cure rate was 84.8%.

Patients with severe forms of tuberculosis (e.g., spine, pericarditis, and disseminated forms) were treated for one year, whereas patients with less severe forms (e.g., pleural effusion, lymphadenopathy, ascites, and abscess) were treated for nine months to one year. Patients were declared “cured” if there was clinical improvement with radiological, microbiological, or laboratory evidence of improvement. 

The team added that the most common antituberculous treatment induced complication was gastritis (36.1%) followed by drug-induced hepatitis (11.1%). “In patients with impaired GFR, the dosing interval of antituberculous drugs should be modified, rather than the actual dose,” stated Dr. John. “Worsening of renal function was seen only in a few, establishing the fact that antituberculous treatment is safe in patients with CKD.”