Latent Tuberculosis Therapy Outcomes in Dialysis Patients: A Retrospective Cohort

Abstract

Rationale & objectives: Maintenance dialysis patients are at an increased risk for active tuberculosis (TB). In 2012, British Columbia, Canada, began systematically screening maintenance dialysis patients for latent TB infection (LTBI) and treating people with evidence of LTBI when appropriate. We examined LTBI treatment outcomes and compared treatment outcomes before and after rollout of the systematic screening program.

Study design: Retrospective cohort study.

Setting & participants: The study comprised 365 people in British Columbia, Canada, initiating at least 90 days of dialysis from January 1, 2001, to May 31, 2017, and starting LTBI therapy: 290 (79.5%) people in the recent cohort and 75 (20.5%) in the historical cohort. People starting LTBI therapy from January 1, 2012, onward were classified as the recent cohort, whereas people starting LTBI therapy before January 1, 2012, were classified as the historical cohort.

Exposure: Systematic LTBI screening and therapy.

Outcomes: Proportion of people who experience grade 3 to 5 adverse events (AEs) or any grade rash and end-of-treatment outcomes.

Analytical approach: Outcomes were reported using descriptive statistics. 2-sample test of proportions using χ² distribution was used to test for statistical significance between the recent and historical cohorts.

Results: 298 (81.6%) people successfully completed LTBI therapy. The proportion of people experiencing a grade 3 to 4 AE or any grade rash was 21.1%. Most AEs were related to gastrointestinal events, general malaise, or pruritus that resulted in regimen changes. 2 (0.5%) people were hospitalized for AEs related to LTBI therapy. No significant difference was found between the recent and historical cohorts in all outcomes of interest. No grade 5 AEs (deaths) were attributed to LTBI therapy.

Limitations: Retrospective data and generalizability outside low-TB-burden settings.

Conclusions: Our findings suggest that a high proportion of people receiving maintenance dialysis can complete LTBI therapy. The rate of grade 3 to 4 AEs was high and associated with frequent medication changes during therapy. LTBI therapy in maintenance dialysis may be safe but requires close monitoring.

Keywords: LTBI therapy; TB registry; Tuberculosis (TB); adverse events; chronic kidney disease (CKD); dialysis; drug intolerance; end-stage renal disease (ESRD); hepatotoxicity; isoniazid; latent tuberculosis infection (LTBI); treatment completion rate; treatment outcomes.