title: Advanced stage of chronic kidney disease is risk of poor treatment outcome for smear-positive pulmonary tuberculosis.
abstract: Chronic kidney disease (CKD) is an increased risk for the development of active tuberculosis, but few studies have analyzed the treatment outcome of pulmonary tuberculosis among CKD patients. A retrospective cohort study was conducted at Chiba-East Hospital in Chiba, Japan. Our study estimated the treatment outcomes in smear-positive pulmonary tuberculosis in relation to CKD and its stages. Total subjects were 759 patients (12-99 years) hospitalized between 2007 and 2012. Patients suffering from multi-drug-resistant tuberculosis were excluded. Patients with CKD were 19.3% aged <65 years (n = 384), and 49.6% aged ≥ 65 years, respectively (P < 0.001). Successful treatment was 52.7% in CKD (n = 260) and 67.3% in non-CKD (n = 499) (P < 0.001). Death was 25.4% in CKD and 12.4% in non-CKD (P < 0.001). Treatment outcome was especially poor in patients with low estimated glomerular filtration rate (eGFR) of <30 ml/min/1.73 m(2), as successful treatment was 20.0%, and death was 50.0%, significantly lower than in other CKD and non-CKD patients. After multivariate logistic regression analysis, eGFR<30 ml/min/1.73 m(2) was an independent factor affecting successful treatment and death, and its adjusted odds ratios (aOR) were 0.20 (95% confidence interval (CI) 0.07-0.50) and 2.99 (95%CI 1.20-7.51), respectively. Other factors affecting successful treatment were serum albumin <3.0 mg/dl, steroid therapy for underlying disease and cardiovascular disease, with aOR (95%CI) of 0.28 (0.20-0.39), 0.32 (0.16-0.63) and 0.49 (0.28-0.86), respectively. Several factors were associated with poor treatment outcome of smear-positive pulmonary tuberculosis. Advanced stage of CKD with eGFR of <30 ml/min/1.73 m(2) was a risk factor for poor treatment outcome.
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; National Hospital Organization Chiba-East Hospital, Clinical Research Center, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; Chiba University Hospital, Division of Infection Control and Treatment, 1-8-1 Inohana, Chuoh-ku, Chiba 260-8677, Japan. Electronic address: hide306@gmail.com.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Igari
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Internal Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; National Hospital Organization Chiba-East Hospital, Clinical Research Center, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Imasawa
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Noguchi
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Nagayoshi
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; National Hospital Organization Chiba-East Hospital, Clinical Research Center, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Internal Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; National Hospital Organization Chiba-East Hospital, Clinical Research Center, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Moritoshi
authors.initials: M
authors.lastname: Kadomura
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Internal Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; National Hospital Organization Chiba-East Hospital, Clinical Research Center, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Motonobu
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: National Hospital Organization Chiba-East Hospital, Department of Respiratory Medicine, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan; National Hospital Organization Chiba-East Hospital, Clinical Research Center, 673 Nitona-cho, Chuoh-ku, Chiba 260-8712, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Yamagishi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002648:Child; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000627:therapeutic use; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D013183:Sputum / Q000382:microbiology; D013256:Steroids / Q000627:therapeutic use; D013307:Streptomycin / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D012709:Serum Albumin; D013256:Steroids; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin
keywords: Chronic kidney disease; Mycobacterium tuberculosis; Pulmonary tuberculosis; Treatment outcome; eGFR TEXT