Tuberculosis outcomes similar with advanced kidney disease

Tuberculosis (TB) remains a major health concern worldwide, but treating TB in people who also have chronic kidney disease (CKD) brings special difficulties. Patients with advanced CKD are often immunosuppressed, they process medicines differently, and in some clinical settings single-drug TB formulations are hard to obtain. To shed light on outcomes in this population in Latin America, corresponding author Karla M. Tamez‐Torres and colleagues reviewed real-world records of adults with confirmed TB over an 11-year period. They conducted an observational, retrospective, age- and sex-matched cohort study that included all patients aged 18 years or older with microbiologically or histologically confirmed TB diagnosed between 2013 and 2024. The team compared people with advanced chronic kidney disease (ACKD), defined by a glomerular filtration rate (GFR) below 30 mL/min/1.73 m2, to matched patients with higher GFRs, focusing on whether ACKD affected one-year all-cause mortality, cure rates, or relapse.

The investigators identified 51 patients in total: 17 with ACKD and 34 without ACKD. CKD was caused by lupus in 29% of patients and by diabetes in 29% as well. Most patients with CKD (68%) received an alternating hemodialysis regimen. The primary outcome was one-year all-cause mortality, and comparisons used Chi-squared and Mann-Whitney U tests, with logistic regression to explore associations. At one year, all-cause mortality was 18% in both groups (p>0.999). TB-related deaths were recorded in 9% of the control group and 0% of the ACKD group. Cure rates were similar (ACKD 88% vs non-ACKD 82%; p=0.586), and no relapses were observed. In bivariate logistic regression, rheumatologic disease was associated with higher mortality (OR 5.31, 95% CI 1.58-24.38) and hepatotoxicity showed a strong association with mortality (OR 20.5, 95% CI 1.82-230.52). ACKD itself was not associated with increased one-year all-cause mortality (OR 1.0, 95% CI 0.22-4.61). Because there were few events, only bivariate models were used.

These findings suggest that, in this cohort, having advanced CKD did not increase the risk of dying within one year after a tuberculosis diagnosis. The study highlights a potential practical strategy: an alternating hemodialysis-aligned regimen may be a workable approach in resource-limited settings where single-drug TB formulations are not available. At the same time, the results underscore that other factors — notably underlying rheumatologic disease and hepatotoxicity during treatment — were linked to worse outcomes and may warrant closer attention during care. The authors caution that the analysis was retrospective, involved a small sample, and used only bivariate regression because of the low number of deaths, so the conclusions must be seen as preliminary. Karla M. Tamez‐Torres and colleagues recommend larger prospective studies to confirm whether ACKD truly does not raise short-term mortality from TB and to test whether dialysis-aligned treatment regimens are safe and effective in broader populations.