Clinical efficacy and pharmacokinetic study of antituberculosis treatment in patients with end-stage renal disease undergoing hemodialysis.

BACKGROUND

Patients with end-stage renal disease (ESRD) undergoing hemodialysis exhibit a 10-25 times greater risk of tuberculosis (TB), underscoring the urgent need for optimized treatment strategies to improve prognosis.

OBJECTIVE

The present study evaluates the efficacy and pharmacokinetics of personalized anti-TB dosing in hemodialysis patients with ESRD and TB, to guide treatment optimization.

METHODS

This retrospective study included 90 hemodialysis patients with ESRD and TB (2020 - 2024). The control group (n = 45) received conventional anti-TB dosing; the study group (n = 45) received individualized dosing/timing. All received HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) and high-flux hemodialysis or hemodiafiltration. Efficacy endpoints included sputum conversion (4, 8, and 12 weeks), imaging at 12 weeks, and clinical effectiveness. Blood samples were collected before/during/after/dialysis intervals to calculate Cmax, Cmin, AUC0-24, CL, CLDAA, ER, t½, and adverse reactions.

RESULT: No significant baseline differences existed between groups (P > 0.05). The study group showed higher sputum conversion rates, 12-week radiographic improvement, and overall effectiveness (P < 0.05). Pharmacokinetic (PK) analysis revealed elevated Cmax, Cmin, AUC0-24 for all anti-TB drugs (P < 0.05). Rifampicin clearance was unchanged (P > 0.05), while others decreased (P < 0.05). Half-life shortened on dialysis days (P < 0.01). Adverse reactions were markedly reduced in the study group (P < 0.01).

CONCLUSIONS

For hemodialysis patients with ESRD and TB, tailoring anti-TB drug regimens based on PK profiles can enhance efficacy and minimize adverse effects, offering a safe and personalized treatment pathway.