Introduction:
Chronic kidney disease (CKD) patients with or without dialysis are at increased risk of tubercular (TB) infection. TB adds significantly to the morbidity and mortality in CKD. In Indian context where there is huge burden of TB, it is important to determine its impact on CKD population. In this retrospective analysis, we determined the clinical presentations, mortality outcome, and complications of anti-tubercular therapy (ATT).
Methods:
In this retrospective analysis, electronic database at our tertiary level kidney care center from central India was scanned. We included CKD patients who had developed pulmonary TB or had extrapulmonary (EP) TB infection. We collected the data on demographics, clinical presentations, outcomes, and treatment complications. Data was analyzed with descriptive statistics. The institutional ethical committee approved this study.
Results:
Between January 2018 and August 2024, a total of 48 CKD patients were diagnosed with TB. Among them, 38 (79.2%) were on dialysis. The median age of the participants was 53 years and 30 (62.5%) were males. Hypertension (n=40, 83.3%) & diabetes (n=22, 45.8%) were common comorbidities. Median duration between the diagnosis of CKD or dialysis and TB infection diagnosis was 270 days (range: 15 to 3118 days). By the site of infection, pulmonary and extrapulmonary TB were observed in 12 (25%) and 33 (68.8%) patients, respectively. Two (4.2%) had both pulmonary and EP involvement and one (2.1%) had latent TB which was detected with QuantiFERON gold assay. In the EP sites, lymph node TB (n=12, 25%) was most common followed by pleural effusion (n=11, 22.9%), abdominal (n=6, 12.5%), central nervous system (n=2, 4.2%), pericardial (n=2, 4.2%), spine (n=2, 4.2%), and ovarian (n=1, 2.1%). Low-grade fever or unresolving fever (n=16, 33.3%) was most common presentation that was accompanied by generalized weakness (n=7, 14.6%). During a median follow-up of 401 days, 33 (68.7%) were alive and 11 (22.9%) had died whereas 4 (8.3%) were lost to follow-up. Three (6.3%) had kidney transplant and TB after transplant occurred in two of them. ATT induced hepatitis occurred in 5 (10.4%) cases, whereas 4 (8.3%) developed isoniazid (INH)-induced encephalopathy, 2 (6.3%) had INH-related peripheral neuropathy, 2 (4.2%) developed isoniazid-induced nausea-vomiting, 3 (6.3%) developed ethambutol-associated visual blurring, and 1 (2.1%) had INH-induced skin rash. Two (4.2%) had rifampicin resistance. Addition of linezolid and moxifloxacin to ATT was done in three (6.3%) cases.
Conclusions:
In CKD with or without dialysis, TB commonly involves EP sites including central nervous system. This makes correct diagnosis difficult. High index of suspicion is necessary to make timely diagnosis & institute ATT. In ATT drugs, INH can be associated with significant neurotoxicity. TB reactivation after kidney transplant remains a possibility that demands regular follow-up.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.