Tuberculosis Management in Chronic Kidney Disease
Summary
Tuberculosis (TB) remains a major global health challenge and is disproportionately common among patients with chronic kidney disease (CKD). The immunocompromised state associated with uraemia and dialysis contributes to an elevated risk of both latent tuberculosis infection (LTBI) and progression to active disease. Management of TB in CKD involves early identification of latent and active infection, careful selection and adjustment of anti-tuberculous drugs to account for renal clearance, and vigilant monitoring for drug toxicity and therapeutic efficacy. CKD alters the pharmacokinetics of first-line agents such as isoniazid, rifampicin and pyrazinamide, necessitating dosage modification based on estimated glomerular filtration rate (eGFR). Diagnostic challenges in CKD include reduced sensitivity of the tuberculin skin test (TST) and increased indeterminate results with interferon-gamma release assays (IGRAs), especially in patients with malnutrition or advanced renal impairment. Furthermore, CKD patients often present with extrapulmonary and atypical manifestations of TB, complicating clinical recognition. Integrated strategies that combine risk stratification, tailored screening protocols, renal function–based dosing and interdisciplinary care are vital to reduce morbidity and mortality in this vulnerable population.
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Tuberculosis Management in Chronic Kidney Disease publication trend
The graph below shows the total number of articles in tuberculosis management in chronic kidney disease across all publications each year (not limited to Nature Index journals).
Technical terms
Chronic kidney disease (CKD): Progressive loss of renal function, classified by reduced eGFR over three months or more.
Latent tuberculosis infection (LTBI): State of immune response to Mycobacterium tuberculosis without clinical or radiological evidence of active disease.
Interferon-gamma release assay (IGRA): Blood test measuring T-cell release of interferon-gamma in response to TB antigens, used to diagnose LTBI.
Tuberculin skin test (TST): Intradermal injection of purified protein derivative to elicit a delayed hypersensitivity reaction, indicative of TB sensitisation.
Estimated glomerular filtration rate (eGFR): Calculated index of renal function based on serum creatinine, age, sex and ethnicity, guiding drug dosage adjustment.
Haemodialysis (HD): Renal replacement therapy in which a patient’s blood is filtered through a dialyser to remove waste products and excess fluid.
References
- Diagnosis of Latent Tuberculosis Infection in Hemodialysis Patients: TST versus T-SPOT.TB. Diagnostics (2023).
- Impact of renal function-based anti-tuberculosis drug dosage adjustment on efficacy and safety outcomes in pulmonary tuberculosis complicated with chronic kidney disease. BMC Infectious Diseases (2019).
- The association between chronic kidney disease and tuberculosis; a comparative cohort study in England. BMC Nephrology (2020).
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