title: Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions.
abstract: BACKGROUND
  The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment.
  
  
  RESULTS
  Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1).
  
  
  CONCLUSIONS
  Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations.
authors: Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, Minn., USA.
authors: Abdurrahman M
authors: AM
authors: Hamadah
authors: Lynn M
authors: LM
authors: Beaulieu
authors: John W
authors: JW
authors: Wilson
authors: Timothy R
authors: TR
authors: Aksamit
authors: James R
authors: JR
authors: Gregoire
authors: Amy W
authors: AW
authors: Williams
authors: John J
authors: JJ
authors: Dillon
authors: Robert C
authors: RC
authors: Albright
authors: Macaulay
authors: M
authors: Onuigbo
authors: Venkateshwaran K
authors: VK
authors: Iyer
authors: LaTonya J
authors: LJ
authors: Hickson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D055985:Latent Tuberculosis / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D006435:Renal Dialysis / Q000009:adverse effects* / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D007538:Isoniazid