Side-effects of antituberculosis drug treatment in patients with chronic renal failure

Abstract

Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB). Those from the Indian subcontinent are at particular risk. The frequency of side-effects associated with antituberculous treatment in a group of patients with CRF was studied. All cases of TB in patients with CRF occurring over a 13-yr period at the Manchester Royal Infirmary, from 1986-1999, were identified by diagnostic coding, microbiology records and a TB database. The case notes were then reviewed. Twenty-four cases were identified, eight predialysis and 16 requiring regular dialysis. TB occurring in the dialysis group was extrapulmonary in every case. Nineteen of 24 (79%) patients were of Indian subcontinent origin and 14 of 16 (87%) dialysis patients were non-Caucasian. Adverse effects of treatment occurred in two of eight (25%) in the predialysis group and nine of 16 (56%) of the dialysis group. These were most commonly neuropsychiatric (6), hepatic (4) and gastrointestinal (4). Neuropsychiatric symptoms occurred exclusively in dialysis patients. In conclusion, a high incidence of side-effects from antituberculous medication, especially neuropsychiatric, hepatic and gastrointestinal, was identified in patients with chronic renal failure. Careful monitoring for side-effects is essential in this group, and consideration should be given to administering antituberculous chemoprophylaxis to all high-risk groups. Eur Respir J 2002; 20: 440-443. Patients with chronic renal failure (CRF) have a high incidence of tuberculosis (TB), possibly due to a decrease in cellular immunity [1-4]. Treatment of TB in CRF may be complicated by an increased risk of toxicity from antituberculous drugs, particularly isoniazid and ethambutol. Current British Thoracic Society (BTS) guidelines lack explicit recommendations for the management of these patients [5]. The Manchester Royal Infirmary (MRI) has a large renal unit with dialysis facilities and a catchment population that includes a high proportion of non-Caucasians, especially from the Indian subcontinent. In this study, all cases of TB occurring in patients with pre-existing CRF over a 13-yr period at the MRI were reviewed. Methods CRF can be defined as an irreversible deterioration of kidney function occurring usually over a period of years. Between 1986-1999, cases of TB in patients with CRF were identified by three methods: medical outpatient coding, microbiology records and the respiratory department TB database. For the purpose of this study, a case of TB was considered to be any patient receiving a course of antituberculous chemotherapy, regardless of whether the diagnosis was based on clinical suspicion or microbiological results. Adverse effects were defined as symptoms and/ or signs thought to be due to antituberculous treatment and of sufficiently serious or severe nature to warrant an alteration in therapy. Patients9 case notes were then inspected and relevant data recorded. All patients were treated at the same institution (MRI) for both CRF and TB. Results Twenty-four cases we...

Tuberculosis in dialysis patients: a nine-year retrospective analysis

“…Treatment of TB in CKD may be complicated by an increased risk of toxicity from antituberculous drugs, particularly isoniazid and ethambutol. Adverse effects of antituberculous treatment have been found to be more common in patients with renal disease than in those with normal renal function (16).…”

Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease

“…There was an unusually high incidence (37%; 6 patients) of neuropsychiatric disturbance, with three cases of encephalopathy, in one series of 16 patients with TB receiving dialysis 74. Other side effects occurred in patients with CKD and TB, but neuropsychiatric symptoms occurred exclusively in patients on dialysis.…”

Incidence of tuberculosis is high in chronic kidney disease patients in South East England and drug resistance common

“…3,4 Adverse reactions to anti-TB treatment are also more common. 5 According to reports by the National Institute for Health and Care Excellence (NICE) UK, the relative risk of developing active TB is 10-25 for patients with CKD, including those on chronic hemodialysis, and 37 for renal transplant recipients. 6 These data are based on historical reports, including a study from 1983.…”