Latent TB treatment in dialysis patients safe but requires close monitoring

Many patients receiving maintenance dialysis can complete latent tuberculosis (TB) infection (LTBI) therapy, a recent study reports. However, the risk of high-grade adverse events (AEs) is high and related to frequent medication changes during therapy.

The retrospective cohort study included 365 patients who had undergone at least 90 days of dialysis and initiated LTBI therapy. Of these, 290 (79.5 percent) people were in the recent cohort (2012 onward) and 75 (20.5 percent) were in the historical cohort (before 2012).

Descriptive statistics were used to report outcomes. Two-sample test of proportions using χ² distribution was applied to test for statistical significance between the recent and historical cohorts.

Majority of the population (n=298, 81.6 percent) successfully completed LTBI therapy. In total, 21.1 percent of patients developed a grade 3 to 4 AE or rash of any grade. Most AEs were related to gastrointestinal events, general malaise, or pruritus that led to changes in their treatment regimen. Two patients (0.5 percent) were hospitalized for AEs related to LTBI therapy.

There were no significant differences observed between the recent and historical cohorts in all outcomes of interest.

Finally, none of grade 5 AEs (deaths) documented were attributed to LTBI therapy.

Maintenance dialysis patients are at an increased risk of active TB, and the present data indicate that LTBI therapy in this population can be safe but requires close monitoring.

The study was limited by the retrospective nature of data and generalizability outside low-TB-burden settings.