[Expert consensus on the treatment of chronic kidney disease with tuberculosis (2022 version)]

    Insights

    Managing chronic kidney disease (CKD) and tuberculosis (TB) requires careful drug selection. This consensus provides guidelines for anti-TB treatment in CKD patients, emphasizing dose adjustments based on kidney function to minimize adverse effects.

    Area of Science:

    • Nephrology
    • Infectious Diseases
    • Pharmacology

    Background:

    • China faces a high burden of chronic kidney disease (CKD) and tuberculosis (TB).
    • CKD patients have increased risk of TB infection, and TB patients often have higher CKD prevalence.
    • The co-existence of CKD and TB presents significant clinical treatment challenges.

    Purpose of the Study:

    • To summarize the clinical characteristics and drug metabolism in patients with co-existing CKD and TB.
    • To establish principles for formulating anti-tuberculosis treatment regimens in CKD patients.
    • To standardize treatment protocols and improve outcomes for this complex patient population.

    Main Methods:

    • Review of clinical and metabolic characteristics of anti-tuberculosis drugs in CKD.
    • Development of treatment guidelines based on estimated Glomerular Filtration Rate (eGFR).
    • Recommendations for drug selection, avoiding nephrotoxic agents and kidney-metabolized drugs where possible.

    Main Results:

    • For mild CKD (eGFR 60-89 ml/min/1.73 m²), standard anti-TB regimens are recommended.
    • For advanced CKD (eGFR <30 ml/min/1.73 m²) and dialysis patients, anti-TB drug doses must be adjusted based on eGFR.
    • Specific regimens are proposed for initial, retreated, and multi-drug-resistant TB in advanced CKD patients.

    Conclusions:

    • This consensus provides a framework for managing TB in CKD patients, focusing on individualized treatment strategies.
    • Optimizing anti-TB regimens based on renal function is crucial for efficacy and safety.
    • Further research is needed to generate more evidence-based data for CKD-TB management.

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