Tuberculosis in Advanced Chronic Kidney Disease.

BackgroundThe management of Tuberculosis (TB) in patients with chronic kidney disease (CKD) presents unique challenges, including an immunosuppressive state, altered drug pharmacokinetics, and limited access to single-drug formulations in our setting. There is a scarcity of real-world evidence on TB outcomes in this population in Latin America. Our study aimed to compare mortality, cure, and relapse rates between TB patients with ACKD and without ACKD. MethodsWe conducted an observational, retrospective, age- and sex-matched cohort study that included all patients aged [&ge;]18 years with microbiologically or histologically confirmed TB between 2013 and 2024. Patients with ACKD (GFR <30 mL/min/1.73 m2 were compared against age- and sex-matched non-ACKD (GFR [&ge;]30 mL/min/1.73 m2) patients. The primary outcome was all-cause mortality at 1 year. Outcomes were compared using the Chi-squared and Mann-Whitney U tests, as well as logistic regression. Results51 patients with tuberculosis were included (17 with ACKD, 34 without ACKD). CKD was caused by lupus or diabetes in 29% of patients each. Most CKD patients (68%) received an alternating hemodialysis regimen. One-year all-cause mortality was 18% in both groups (p>0.999), and TB-related mortality was 9% in the control group, vs 0% in the ACKD group. The cure rate was similar between groups (ACKD: 88% vs. non-ACKD: 82%; p=0.586). No relapses occurred. Rheumatologic disease (OR 5.31 (95%CI 1.58-24.38) and hepatotoxicity (OR 20.5 (95%CI 1.82-230.52) were associated with increased mortality, whereas ACKD was not (OR 1.0 (95%CI 0.22-4.61). Due to the low event rate, only bivariate logistic regression was used to identify factors associated with mortality. ConclusionsIn our study, ACKD was not associated with one-year all-cause mortality. The alternating hemodialysis-aligned regimen may be a viable strategy in resource-limited settings where individual drug formulations are unavailable. Our findings need to be confirmed in larger prospective studies.