TOLERABILITY OF TB DRUGS BY STAGE 5 CKD PATIENTS ON RENAL REPLACEMENT THERAPY

Objective: to analyze adverse events (AE) in stage 5 chronic kidney disease (CKD) patients on renal replacement therapy (RRT); differentiate between AE and complications of the underlying disease; evaluate tolerability of the recommended TB treatment regimens, including the association with renal disease etiology. Materials and methods. The study enrolled 32 stage 5 CKD patients on RRT (haemodialysis) with TB infection. We analyzed AE due to TB treatment, studied the correlation between AE and other factors (the number and nature of concomitant diseases, body mass index (BMI), severity of the disease at patient’s referral, etiology of the underlying disease). Results. The patients received 22 regimens by the moment of drug administration: 7 preventive and 15 therapeutical regimens for TB infection. More than half of stage 5 CKD patients with TB infection had contraindications or limitations to the use of pyrazinamide (53%), mostly due to underlying kidney disease (82.4%) manifested as elevated uric acid levels in the blood plasma and reduced effectiveness of hypouricemic agents. During TB treatment most patients (71.9%) developed AE which were not directly associated with TB drugs. The statistical analysis did not reveal any correlation between the number and nature of concomitant diseases, BMI, RRT duration by the time of patient referral and the number of AE in stage 5 CKD patients. We established that AE without an unambiguous cause-and-effect relationship with TB treatment were more typical for patients with stage 5 CKD preconditioned by diabetic nephropathy than patients with stage 5 CKD and end-stage chronic glomerulonephritis. Conclusion. It is necessary to develop individualized TB treatment regimens for stage 5 CKD patients for both preventive and therapeutical purposes.