Advanced stage of chronic kidney disease is risk of poor treatment outcome for smear-positive pulmonary tuberculosis

作者：Igari Hidetoshi^*; Imasawa Toshiyuki; Noguchi Naoko; Nagayoshi Masaru; Mizuno Satoko; Ishikawa Satoru; Kadomura Moritoshi; Nishimura Motonobu; Yamagishi Fumio

来源：Journal of Infection and Chemotherapy, 2015, 21(8): 559-563.

DOI：10.1016/j.jiac.2015.04.008

• Pulmonary tuberculosis
• Chronic kidney disease
• Treatment outcome
• Mycobacterium tuberculosis
• eGFR TEXT

Chronic kidney disease (CKD) is an increased risk for the development of active tuberculosis, but few studies have analyzed the treatment outcome of pulmonary tuberculosis among CKD patients. A retrospective cohort study was conducted at Chiba-East Hospital in Chiba, Japan. Our study estimated the treatment outcomes in smear-positive pulmonary tuberculosis in relation to CKD and its stages. Total subjects were 759 patients (12-99 years) hospitalized between 2007 and 2012. Patients suffering from multi-drug-resistant tuberculosis were excluded. Patients with CKD were 19.3% aged <65 years (n = 384), and 49.6% aged > 65 years, respectively (P < 0.001). Successful treatment was 52.7% in CKD (n - 260) and 67.3% in non-CKD (n - 499) (P < 0.001). Death was 25.4% in CKD and 12.4% in non-CKD (P < 0.001). Treatment outcome was especially poor in patients with low estimated glomerular filtration rate (eGFR) of < 30 ml/min/1.73 m(2), as successful treatment was 20.0%, and death was 50.0%, significantly lower than in other CKD and non-CKD patients. After multivariate logistic regression analysis, eGFR<30 ml/min/1.73 m(2) was an independent factor affecting successful treatment and death, and its adjusted odds ratios (aOR) were 0.20 (95% confidence interval (CI) 0.07-0.50) and 2.99 (95% CI 1.20-7.51), respectively. Other factors affecting successful treatment were serum albumin <3.0 mg/dl, steroid therapy for underlying disease and cardiovascular disease, with aOR (95% CI) of 0.28 (0.20-0.39), 0.32 (0.16-0.63) and 0.49 (0.28-0.86), respectively. Several factors were associated with poor treatment outcome of smear-positive pulmonary tuberculosis. Advanced stage of CKD with eGFR of < 30 ml/min/1.73 m(2) was a risk factor for poor treatment outcome.

• 出版日期2015-8