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 C max , C min , AUC 0–24 , CL, CLDAA, ER, t ½ , 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 C max , C min , AUC 0–24 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.