Abstract
Introduction: Balancing side effects against effective tuberculosis (TB) treatment in Chronic Kidney Disease (CKD) can be difficult leading to variations in management. We reviewed patients with CKD and TB to investigate compliance with new treatment guidelines by the British Thoracic Society. 1
Methods: Retrospective review of patient case notes with CKD who developed TB between 1994-2010 in a single tertiary hospital. Categories included drug dosage, side effects, treatment duration, respiratory team input and outcome.
Results: We reviewed the notes of 40 patients. 11 had incomplete data. In 73% (52/71) of prescriptions dosing regimens were consistent with BTS guidelines. Errors included over-dosing of Rifater and Isoniazid in 2 patients, and under-dosing of ethambutol and isoniazid in 13 patients. Daily dosing of ethambutol (10/14) and pyrazinamide (10/12) in haemodialysis patients was common and not ideal. Side effects were recorded in 22/29 patients: 3 rifampicin, 5 isoniazid, 3 ethambutol, 4 pyrazinamide, 1 streptomycin and 6 to any/combination drugs. Increased treatment duration (12/29 cases) due to side effects was common. All patients were cured and 23/29 (79%) received specialist respiratory physician input.
Conclusion: Management of TB in CKD patients was variable. Side effects from anti- TB drugs were common. Overall outcome was good, but not all patients received respiratory physician input. The new BTS guidelines for drug regimens will hopefully standardise management of CKD patients with TB.
1.BTS Standards of Care Committee, Guidelines for the prevention and management of Mycobacterium TB infection and disease in adult patients with CKD. Thorax 2010: 65: 559-570
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