Introduction:
Patients on continuous hemodialysis are more prone to tuberculosis (TB) and other illnesses than the general population with an incidence of 105.9 per 1000 patient years. Risk factors are Male gender, diabetes mellitus, past history of tuberculosis, low serum albumin, and duration of haemodialysis more than 24 months. Pharmacokinetic studies of first-line anti-tubercular drugs in CKD are sparse. Therefore, the aim of the study was to measure the anti-tubercular drug concentrations in CKD-5D pre- and post-dialysis.
Methods:
After permission from institutional ethics committee, we conducted a prospective observational study to assess the concentration of first-line anti-tubercular drugs in individuals with CKD on dialysis. Demographic details were recorded in a case record form and plasma samples were collected both before and after dialysis to measure the pre and post drug levels using Liquid Chromatography-Mass Spectrometry (LC-MS). Data analysis was done using SPSS version 29.
Results:
Of 17 CKD on dialysis patients, ten were male; mean age was 54.0±13.3; Six had diabetes mellitus and eleven had hypertension; four had pulmonary TB and thirteen had extrapulmonary tuberculosis. There was significant fall of drug concentrations after dialysis for Isoniazid, ethambutol and pyrazinamide (Table-1). The concentration of rifampicin increased after dialysis in seven/17. Out of 17, four patients had adverse drug reactions including two with hepatitis, one optic neuritis, and one psychosis.
Table-1: - Comparison of drug concentrations between pre- and post- dialysis in chronic kidney disease- 5D
Conclusions:
Extrapulmonary tuberculosis was predominant in CKD-5D. There was fall in drug concentration after dialysis for Isoniazid, Ethambutol, and Pyrazinamide in all patients and increase in rifampicin levels after dialysis in some. This suggests potential under treatment and need for dosing after dialysis for three main drugs and possible chance of adverse drug reactions with rifampicin.
I have potential conflict of interest to disclose.
This study was part of a project to measure anti-tubercular drug levels in all stages of CKD and funded by an Indian Council of Medical Research (ICMR) grant.
I did not use generative AI and AI-assisted technologies in the writing process.