Effect of kidney function on drug concentrations of first-line anti-tubercular treatment.
Background: Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug mon...
| Publicado en: | Infection pp. 1 - 17 |
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| Autores principales: | , , , , , , , , , , , , , , |
| Formato: | Journal Article |
| Publicado: |
Springer Nature
Aug2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=196593696&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 196593696 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03008126 NXO jtl: Infection issn: 03008126 maglogo: N pubinfo: dt: Aug2026 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 196593696 10.1007/s15010-026-02931-7 196593696 ppf: 1 ppct: 16 formats: tig: atl: Effect of kidney function on drug concentrations of first-line anti-tubercular treatment. aug: au: Datta, Divya Rao, Indu Ramachandra Shetty, Raghavendra Nagaraju, Shankar Prasad Thunga, Girish Magazine, Rahul Nagri, Shivashankara Kaniyoor Khader, Nisha Abdul Tejashree, Pasumarthi Mallayasamy, Surulivelrajan Tirlangi, Praveen Kumar Rangaswamy, Dharshan Shenoy, Srinivas Vinayak Bhojaraja, Mohan V. Prabhu, Attur Ravindra affil: Department of Nephrology, Kasturba Medical College, Manipal Academy of Higher Education sug: ab: Background: Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function.A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function.Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), <italic>P</italic> < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), <italic>P</italic> < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), <italic>P</italic> < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), <italic>P =</italic> 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7%) vs. 48/100 (48%), <italic>P</italic> = 0.059] and pyrazinamide [39/40 (97.5%) vs. 29/91 (31.8%), <italic>P</italic> < 0.0001].CKD affects anti-tubercular drug concentrations, highlighting the need for therapeutic drug monitoring.CTRI/2020/09/027951.Methods: Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function.A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function.Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), <italic>P</italic> < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), <italic>P</italic> < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), <italic>P</italic> < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), <italic>P =</italic> 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7%) vs. 48/100 (48%), <italic>P</italic> = 0.059] and pyrazinamide [39/40 (97.5%) vs. 29/91 (31.8%), <italic>P</italic> < 0.0001].CKD affects anti-tubercular drug concentrations, highlighting the need for therapeutic drug monitoring.CTRI/2020/09/027951.Results: Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function.A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function.Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), <italic>P</italic> < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), <italic>P</italic> < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), <italic>P</italic> < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), <italic>P =</italic> 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7%) vs. 48/100 (48%), <italic>P</italic> = 0.059] and pyrazinamide [39/40 (97.5%) vs. 29/91 (31.8%), <italic>P</italic> < 0.0001].CKD affects anti-tubercular drug concentrations, highlighting the need for therapeutic drug monitoring.CTRI/2020/09/027951.Conclusion: Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function.A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function.Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), <italic>P</italic> < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), <italic>P</italic> < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), <italic>P</italic> < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), <italic>P =</italic> 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7%) vs. 48/100 (48%), <italic>P</italic> = 0.059] and pyrazinamide [39/40 (97.5%) vs. 29/91 (31.8%), <italic>P</italic> < 0.0001].CKD affects anti-tubercular drug concentrations, highlighting the need for therapeutic drug monitoring.CTRI/2020/09/027951.Clinical trial registration number: Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function.A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function.Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), <italic>P</italic> < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), <italic>P</italic> < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), <italic>P</italic> < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), <italic>P =</italic> 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7%) vs. 48/100 (48%), <italic>P</italic> = 0.059] and pyrazinamide [39/40 (97.5%) vs. 29/91 (31.8%), <italic>P</italic> < 0.0001].CKD affects anti-tubercular drug concentrations, highlighting the need for therapeutic drug monitoring.CTRI/2020/09/027951. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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