Should Tuberculosis Prophylaxis Be Given for the Chronically Dialyzed Patients?

The preventive treatment of latent tuberculosis infection (LTBI) is of great importance for the elimination and control of tuberculosis (TB) worldwide, but existing screening methods for LTBI are still limited in predicting the onset of TB. Previous studies have found that some high-risk factors (including human immunodeficiency virus (HIV), organ transplantation, silicosis, tumor necrosis factor-alpha blockers, close contacts and kidney dialysis) contribute to a significantly increased TB reactivation rate. This article reviews each risk factor's association with TB and approaches to address those factors. Five regimens are currently recommended by the World Health Organization, and no regimen has shown superiority over others. In recent years, studies have gradually narrowed down to the preventive treatment of LTBI for high-risk target groups, such as silicosis patients, organ-transplantation recipients and HIV-infected patients. This review discusses regimens for each target group and compares the efficacy of different regimens. For HIV patients and transplant recipients, isoniazid monotherapy is effective in treating LTBI, but for others, little evidence is available at present.

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“… 21 Currently, in several guidelines and reports, testing and prophylaxis of LTBI in CRF patients are suggested. 41 , 50 , 51 , 52 …”

Section: Risk Factors For Tuberculosis Reactivationmentioning

confidence: 99%

Updates on the risk factors for latent tuberculosis reactivation and their managements

Ruan

Liu

et al. 2016

Emerging Microbes & Infections

202

167

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“…The diagnosis of TB is hampered by the common occurrence of a negative purified protein derivative (PPD) (Mantoux) skin test, which was found in 40–100% of the cases (Table 1). Somewhat paradoxically, and despite the high rate of anergy to intracutaneously administered antigens in uremic patients, high rates of positive Mantoux tests (6.1–19%) have been found in routine screening of dialysis patients without a history of or active TB (31,34,35,42,43). Thus, due to the frequent extrapulmonary presentation and nonspecific symptomatology, a high index of suspicion is required, coupled with a need for invasive procedures, including liver, bone, lymph node, and peritoneal biopsies (11).…”

Section: Diagnosismentioning

confidence: 99%

“…In view of the high prevalence of TB in the dialysis population, several reports have recommended TB prophylaxis in high‐risk patients such as those with a positive Mantoux skin test and radiographs suggestive of old TB (22–24,31,34,42,43,50). A joint statement of the American Thoracic Society (ATS) and the Centers for Disease Control and Prevention (CDC) also recommends TB prophylaxis (or treatment of latent TB infection; LTBI) in patients with chronic renal failure when the tuberculin positivity is ≥10 mm of induration.…”

Section: Prophylaxismentioning

confidence: 99%

“…Even if there is a high rate of anergy to intracutaneously administered antigens in dialysis patients, routine tuberculin skin test screening of all patients entering a dialysis program has been recommended, and, if negative, the test should be repeated with higher‐strength solution (250 U dose) (42,43). The drug of choice is isoniazid, which can be administered two to three times a week under supervision in the dialysis unit in a dose of 15 mg/kg/dose for a period of 6–9 months (42,51).…”

Section: Prophylaxismentioning

confidence: 99%

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Tuberculosis and Chronic Renal Disease

Hussein

Mooij

Roujouleh

2003

Seminars in Dialysis

181

164

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There is an increased risk (6.9- to 52.5-fold) of tuberculosis (TB) in patients with chronic renal failure and on dialysis as compared to the general population. The symptomatology in renal patients is often insidious and nonspecific, mimicking uremic symptoms, whereas the localization is often extrapulmonary (most frequently tuberculous lymphadenitis and peritonitis). Tuberculous peritonitis makes up a large part (37%) of the total number of TB cases in continuous ambulatory peritoneal dialysis (CAPD) patients. The prognosis is very much dependent on early diagnosis and treatment. Renal physicians should be aware of the unusual presentation and localization, and include TB in the differential diagnosis of any patient having nonspecific symptoms like anorexia, fever, and weight loss. All efforts should then be made (including invasive investigations) to reach an early diagnosis, a major determinant of the outcome. However, if this is not possible or the result is negative and the diagnosis remains strongly suspected, an empirical trial with anti-TB medication is justified, especially in endemic areas. In view of the increased prevalence of the disease in the dialysis population, TB prophylaxis is recommended in those patients with a positive tuberculin (Mantoux) skin test and radiographs suggestive of old TB.

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“…Reactivation of old, healed primary or post‐primary lesions has been noted as the most common form of TB in patients on renal replacement therapy (RRT), because of their long‐term immunocompromised state owing to uremia and immunosuppressive therapy (2, 3). Worldwide TB infection in patients on dialysis ranges from 5% to 28% (4–6), which is several times higher than in the general population. The incidence of TB in India in dialysis patients alone ranges between 10% and 15% (7–9).…”

mentioning

confidence: 99%

Prospective randomized control trial of isoniazid chemoprophylaxis during renal replacement therapy

Vikrant¹,

Agarwal²,

Gupta³

et al. 2005

Transplant Infectious Dis

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This study shows significant efficacy of INH chemoprophylaxis during RRT in preventing development of TB, when the INH was started during dialysis itself. INH chemoprophylaxis was safe and well tolerated in the majority of patients. However, mild hepatic dysfunction was common, both in the treatment as well as in the control group. As the incidence of viral hepatitis overall was high in our patients on RRT, it is difficult to identify INH-induced hepatitis in this clinical setting.

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Should Tuberculosis Prophylaxis Be Given for the Chronically Dialyzed Patients?

Cited by 6 publications

References 25 publications

Updates on the risk factors for latent tuberculosis reactivation and their managements

Updates on the risk factors for latent tuberculosis reactivation and their managements

Tuberculosis and Chronic Renal Disease

Prospective randomized control trial of isoniazid chemoprophylaxis during renal replacement therapy

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