Management of latent tuberculosis infection in patients with kidney disease
3
Issued Date
2026-06-01
Resource Type
ISSN
08938512
eISSN
10986618
Scopus ID
2-s2.0-105041947297
Pubmed ID
42007724
Journal Title
Clinical Microbiology Reviews
Volume
39
Issue
2
Rights Holder(s)
SCOPUS
Bibliographic Citation
Clinical Microbiology Reviews Vol.39 No.2 (2026)
Suggested Citation
Chancharoenthana W., Siripoon T., Kamolratanakul S., Luvira V., Phumratanaprapin W., Schultz M.J., Ronco C., Pitisuttithum P. Management of latent tuberculosis infection in patients with kidney disease. Clinical Microbiology Reviews Vol.39 No.2 (2026). doi:10.1128/cmr.00353-25 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/117492
Title
Management of latent tuberculosis infection in patients with kidney disease
Author's Affiliation
Corresponding Author(s)
Other Contributor(s)
Abstract
Latent tuberculosis infection (LTBI) is common and preventable among patients with chronic kidney disease (CKD), where uremia and iatrogenic immunosuppression heighten reactivation risk. This narrative review synthesizes evidence across pre-dialysis CKD, dialysis, and kidney transplantation to propose a pragmatic care pathway. In advanced CKD, the tuberculin skin test performs poorly, whereas interferon-γ release assays (IGRAs) are preferred. Screening should be risk-targeted in pre-dialysis CKD, systematic at dialysis initiation, and mandatory pre-transplant for candidates and living donors. Following a positive test, clinicians must exclude active tuberculosis via clinical assessment and chest imaging before starting preventive therapy. Short-course rifamycin-based regimens (4 months of daily rifampin [4R], 3 months of once‑weekly isoniazid plus rifapentine [3HP], or 3 months of daily isoniazid plus rifampin [3HR]) enhance completion rates compared with 9 months of daily isoniazid (9H). In transplant recipients, rifamycin interactions with calcineurin and Mammalian target of rapamycin (mTOR) inhibitors typically favor 9H; rifamycins demand expert multidisciplinary management with intensive therapeutic drug monitoring. Programmatic data from dialysis units show high completion with tolerable toxicity, affirming routine feasibility. We integrate IGRA-based screening at critical transitions with tailored regimen selection, pyridoxine coadministration for isoniazid, and structured safety monitoring. Priorities include validating novel Mycobacterium tuberculosis antigen-based skin tests in CKD and developing implementation strategies to standardize renal care. We delineate setting-specific approaches for high- versus low-burden countries, addressing subclinical and incipient TB challenges in high-burden contexts. Adopting this framework can curb active TB progression, safeguard grafts, and enhance patient outcomes.