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[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.
Abstract:
China is a country with a high burden of chronic kidney disease(CKD) and tuberculosis. Patients with CKD are at increased risk of Mycobacterium tuberculosis infection, and the prevalence of CKD is also significantly higher in patients with tuberculosis. The coexistence of the two diseases brings great difficulties for clinical treatment. In this consensus, the general situation, clinical characteristics, metabolic characteristics of anti-tuberculous drugs, and the principles of protocol formulation of such patients were discussed and summarized. When making anti-tuberculosis regimen for patients with chronic renal failure, drugs that metabolized through liver, liver and kidney channels or metabolic pathways other than liver and kidney should be selected as far as possible. Drugs with significant renal toxicity and mainly metabolized by the kidney should be avoided. For CKD patients with mild decrease in GFR (60-89 ml·min-1·1.73 m-2), anti-tuberculosis regimen should be carried out according to the national standards and guidelines, without reducing the dose of anti-tuberculosis drugs. For CKD patients with significantly reduced GFR, mainly CKD3b, stages 4-5, and those receiving dialysis, the anti-tuberculosis regimen must be adjusted according to the GFR. For CKD patients with GFR less than 30 ml·min-1·1.73 m-2, this consensus also recommended anti-tuberculous regimen for initial, retreated and multi-drug-resistant tuberculosis patients. This consensus aimed to improve clinicians' understanding of CKD complicated with tuberculosis, standardize the clinical treatment, improve the curative effect, and reduce adverse reactions. Data from previous trials of CKD combined with TB treatment are still scarce. We look forward to further investigation and evidence-based medical research on CKD with tuberculosis in the future, and make positive efforts for the control of CKD and tuberculosis in China.
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