Tuberculosis remains a major global public health challenge, with the WHO reporting approximately 10 million new cases and 1.5 million deaths annually. Among the most vulnerable groups are patients with chronic kidney disease, whose immunosuppressed state ‒ either due to the disease itself or to post-transplant immunosuppressive therapy ‒ significantly increases the risk of developing active tuberculosis. The main objective of this study was to evaluate gaps in the diagnosis and treatment process of tuberculosis in patients with chronic renal failure, aiming to identify critical points for improving care for this population. Retrospective analysis of medical records of patients with tuberculosis treated at a tertiary hospital. Cases with chronic kidney disease were included. Statistical tests used were Chi-Square, Fisher’s exact test, and Mann-Whitney (p<0.05). Software: EPI-INFO 7.2.6.0. The mean age of the population was 51.8 years. Although the pulmonary form was the most frequent, a high proportion of extrapulmonary cases was observed (46.6%). Screening for latent tuberculosis was performed in only 8.3% of patients, exclusively using the tuberculin skin test, with no cases investigated using interferon-gamma release assays. Clinical outcomes showed that 61.6% of patients achieved cure, while 10% died directly due to tuberculosis and 25% died from other associated causes. Statistical analysis demonstrated that use of the RHZE regimen was associated with better survival, whereas the presence of positive sputum smear microscopy correlated with higher risk of death, both with statistical significance. The results highlight important gaps in the care of patients with tuberculosis and chronic kidney disease. Notably, there was a low rate of latent tuberculosis screening, absence of use of the most appropriate diagnostic methods for this specific population, frequent diagnostic delay ‒ especially in extrapulmonary forms ‒ and a high occurrence of treatment-related adverse events. These findings reinforce the need to develop specific clinical protocols that consider the particularities of this population, with special attention to toxicity monitoring and dosage adjustments according to renal function, aiming to improve clinical outcomes in this high-risk group.
Sforcin et al. (Sun,) studied this question.