Impact of chronic renal failure on anti-tuberculosis treatment outcomes

Baghaei, Parvaneh; Marjani, Majid; Tabarsi, Payam; Moniri, Afshin; Rashidfarrokhi, F; Ahmadi, Farrokhlagha; Nassiri, Amirahmad; Mr, Masjedi; Velayati, Ali Akbar; Cattamanchi, Adithya

doi:10.5588/ijtld.13.0726

Cited by 24 publications

(24 citation statements)

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“…Pyrazinamide is also metabolized in the liver, but its metabolite may accumulate in patients with renal failure, as may ethambutol, since its metabolism occurs mainly (80%) in the kidneys; therefore, for these two medications, the recommended use is 3 times a week. 41 , 42 …”

Section: Tuberculosis and Renal Failurementioning

confidence: 99%

Tuberculosis treatment

et al. 2017

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Tuberculosis treatment remains a challenge due to the need to consider, when approaching it, the context of individual and collective health. In addition, social and economic issues have been shown to be variables that need to be considered when it comes to treatment effectiveness. We conducted a critical review of the national and international literature on the treatment of tuberculosis in recent years with the aims of presenting health care workers with recommendations based on the situation in Brazil and better informing decision-making regarding tuberculosis patients so as to minimize morbidity and interrupt disease transmission.

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Section: Tuberculosis and Renal Failurementioning

confidence: 99%

Tuberculosis treatment

et al. 2017

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“…The selection of variables included in the multivariate analysis was performed based on previous studies investigating risk factors for mortality ( Alvarez-Uria et al, 2012a ; Alvarez-Uria et al, 2013b ; Alvarez-Uria et al, 2014a ; Alvarez-Uria et al, 2014b ; Kim et al, 2012 ; Baghaei et al, 2014 ). Designation of the community of patients was performed by self-identification.…”

Section: Methodsmentioning

confidence: 99%

Mortality in HIV-infected patients with tuberculosis treated with streptomycin and a two-week intensified regimen: data from an HIV cohort study using inverse probability of treatment weighting

Alvarez-Uria¹,

Midde²,

Naik³

2016

PeerJ

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Background. Despite the dramatic scale-up of antiretroviral therapy in low- and middle-income countries, tuberculosis (TB) is still the main cause of death among HIV-infected patients in resource-limited settings. Previous studies in patients with TB meningitis suggest that the use of higher doses of common anti-TB drugs could reduce mortality.Methods. Using clinical data from an HIV cohort study in India, we compared the mortality among HIV-infected patients diagnosed with TB according to the regimen received during the first two weeks of treatment: standard anti-tuberculosis therapy (ATT) (N = 847), intensified ATT (N = 322), and intensified ATT with streptomycin (N = 446). The intensified ATT comprised double dose of rifampicin and substitution of ethambutol with levofloxacin. Multivariate analysis was performed using Cox proportional hazard models and inverse probability of treatment weighting (IPTW) based on propensity scores. Patients with TB meningitis were excluded.Results. The use of intensified ATT alone did not improve survival. However, when streptomycin was added, the use intensified ATT was associated with reduced mortality in Cox models (adjusted hazard ratio 0.72, 95% CI [0.57–0.91]) and after IPTW (hazard ratio 0.77, 95% CI [0.67–0.96]). Other factors associated with improved survival were high serum albumin concentration, high CD4 lymphocyte cell-counts, and high glomerular filtration rates. Factors associated with increased mortality were high urea concentrations, being on antiretroviral therapy at the time of ATT initiation and high BUN/creatinine ratio. In an effect modification analysis, the survival benefits of the intensified ATT with streptomycin disappeared in patients with severe hypoalbuminemia.Conclusion. The results of this study are in accordance with a previous study from our cohort involving patients with TB meningitis, and suggest that an intensified 2-week ATT with streptomycin could reduce mortality in HIV infected patients with TB. As this is an observational study, we should be cautious about our conclusions, but given the high mortality of HIV-related TB, our findings deserve further research.

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“…Patients with end-stage renal disease (ESRD) are at increased risk for reactivation TB and for worse outcomes related to TB. 81 PZA metabolites and EMB are cleared renally and require dose adjustment for patients with creatinine clearance less than 30 mL/min. The recommendation is to give the usual daily dose at an interval of three times per week.…”

Section: Renal Diseasementioning

confidence: 99%

Updates in the Treatment of Active and Latent Tuberculosis

Haas

Belknap

2018

Semin Respir Crit Care Med

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First-line therapy for active tuberculosis (TB) has remained unchanged for nearly 40 years. Isoniazid, rifampin, pyrazinamide, and ethambutol for the initial two-month phase followed by isoniazid and rifampin for 4 to 7 months is standard treatment for people at low risk for drug-resistant disease. Directly-observed therapy (DOT) remains the standard of care for pulmonary TB. Virtual treatment monitoring using digital technologies is becoming more common as a way to provide a more patient-centered approach to care. Attempts to shorten treatment duration have been unsuccessful based on recent clinical trials evaluating the role of fluoroquinolones. Treatment-shortening trials using higher doses of rifamycins are currently underway. Recently approved medications for TB treatment are recommended only for drug-resistant disease, but novel agents in varying stages of development are being evaluated. Rifamycin-based regimens for latent TB infection (LTBI) have been successful in preventing progression to TB disease. Once-weekly isoniazid and rifapentine for 12 weeks by DOT was shown to be safe and effective compared with 9 months of isoniazid. The same regimen was shown to have acceptable treatment completion when given self-administered. Newer studies are investigating even shorter LTBI treatment with durations of less than 2 months. Treatment of LTBI in people likely infected with multidrug resistant TB is very limited, but one observational study found that fluoroquinolones appear to be effective. The first randomized trials for treating LTBI in contacts to MDR-TB are currently enrolling.

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Impact of chronic renal failure on anti-tuberculosis treatment outcomes

Abstract: TB patients with CRF are at increased risk of death. More intensive monitoring of patients with CRF should be considered by the National TB Programme.

Cited by 24 publications

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Tuberculosis treatment

Tuberculosis treatment

Mortality in HIV-infected patients with tuberculosis treated with streptomycin and a two-week intensified regimen: data from an HIV cohort study using inverse probability of treatment weighting

Updates in the Treatment of Active and Latent Tuberculosis

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