Latent tuberculosis therapy may be safe in maintenance dialysis
Latent tuberculosis infection therapy in maintenance dialysis may be safe if combined with close follow-up and monitoring, according to results from a recently published study.
“World Health Organization guidelines recommend latent tuberculosis infection (LTBI) screening and treatment in maintenance dialysis patients ... However, several potential barriers to LTBI therapy are encountered in this population, including the perception that maintenance dialysis patients are at increased risk of adverse events from LTBI therapy,” Leslie Y. Chiang, BSc, of the British Columbia Centre for Disease Control, and colleagues wrote in their study. “Knowledge gaps remain in the literature regarding LTBI therapy outcomes among maintenance dialysis patients, as well as in studies that address adverse events in this population.”
In a retrospective cohort study, researchers included 365 patients initiating at least 90 days of dialysis and beginning LTBI therapy for the analysis. Patients were further categorized into two cohorts (recent cohort n= 290 patients, historic cohort n= 75 patients) who received standard baseline testing, as well as monthly bloodwork and treatment monitoring. Investigators performed statistical analysis for significance between the cohort treatment outcomes and graded adverse events on a scale of 1 to 5.
Study results showed an 81.6% LTBI therapy completion rate (80.7% recent cohort vs. 85.3% historic cohort), with 21.1% of patients experiencing a grade 3 to 4 adverse event. Two patients were hospitalized due to adverse events, although no grade 5 adverse events were attributed to LTBI therapy. Further, no significant difference was found between the two cohorts in study outcome analysis.
“In our study population, there was no significant difference when comparing proportions of people with grade 3 to 4 adverse events,” Chiang and colleagues concluded. “LTBI therapy in the maintenance dialysis population may be safe if combined with close follow-up and monitoring by experienced clinicians ... Further studies are required to assess the optimal approach to tuberculosis prevention and treatment in the maintenance dialysis population.”