Acute Kidney Injury Due to Anti-tuberculosis Drugs
Acute Kidney Injury Due to Anti-tuberculosis Drugs
Tuberculosis (TB) is a global disease affecting one-third of the world's population. In 2011, around 60% of new TB cases worldwide were in Asia. In Taiwan, the incidence of TB is around 57 cases per 100,000 population. Prompt anti-tuberculosis treatment remains the most important and effective intervention for controlling spread, but adverse events from first-line anti-TB drugs are not uncommon. Acute kidney injury (AKI) is a rare and severe complication that can interrupt treatment and cause permanent kidney damage. Although isoniazid (INH) and ethambutol (EMB) have been associated with AKI, rifampin (RIF) is the most common anti-TB drug responsible for AKI identified by most studies.
Reviewing literature of rifampin-induced AKI, the mean age of reported cases is around 40–45 years and the recovery rate ranges from 83% to 96%. However, the incidence to rifampin-induced AKI is uncertain because the definitions of AKI used in previous studies vary. The largest study disclosed that 60 out of 120,132 (0.05%) patients developed AKI. Because the elderly are more vulnerable to drug-induced AKI and usually have poor renal recovery, AKI during anti-TB treatment may be more common and serious in Taiwan, where more than 50% of TB patients are older than 65 years. Furthermore, prognostic factors have never been investigated.
The present study was conducted to investigate the incidence of AKI during anti-TB treatment in Taiwan and to determine outcomes and predictive factors for renal recovery.
Background
Tuberculosis (TB) is a global disease affecting one-third of the world's population. In 2011, around 60% of new TB cases worldwide were in Asia. In Taiwan, the incidence of TB is around 57 cases per 100,000 population. Prompt anti-tuberculosis treatment remains the most important and effective intervention for controlling spread, but adverse events from first-line anti-TB drugs are not uncommon. Acute kidney injury (AKI) is a rare and severe complication that can interrupt treatment and cause permanent kidney damage. Although isoniazid (INH) and ethambutol (EMB) have been associated with AKI, rifampin (RIF) is the most common anti-TB drug responsible for AKI identified by most studies.
Reviewing literature of rifampin-induced AKI, the mean age of reported cases is around 40–45 years and the recovery rate ranges from 83% to 96%. However, the incidence to rifampin-induced AKI is uncertain because the definitions of AKI used in previous studies vary. The largest study disclosed that 60 out of 120,132 (0.05%) patients developed AKI. Because the elderly are more vulnerable to drug-induced AKI and usually have poor renal recovery, AKI during anti-TB treatment may be more common and serious in Taiwan, where more than 50% of TB patients are older than 65 years. Furthermore, prognostic factors have never been investigated.
The present study was conducted to investigate the incidence of AKI during anti-TB treatment in Taiwan and to determine outcomes and predictive factors for renal recovery.