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Update of the mechanism and characteristics of tuberculosis in chronic kidney disease

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Summary

The risk of tuberculosis (TB) is significantly increased in patients with chronic kidney disease (CKD), which is closely related to hyperparathyroidism, malnutrition and oxidative stress as well as immune deficiency in patients with end-stage renal disease (ESRD). Vitamin D deficiency and gender bias are independent risk factors. In the TB screening and diagnosis test of CKD, interferon-gamma release assays (IGRA), including T‑SPOT.TB test (T-SPOT) and QuantiFERON-TB Gold In-Tube (QFT-GIT) have been available. Many studies have found that they are more sensitive and specific than tuberculin skin test (TST). At present, IGRA has been used to study various types of immunocompromised patients. For CKD patients with TB, the choice and dosage of anti-TB drugs need to be reconsidered. Weekly treatment with rifapentin (RFT) and isoniazid (INH) for 3 months is an effective treatment for latent tuberculosis infection (LTBI) in hemodialysis (HD) patients. Therefore, in this review we discuss CKD and TB, its pathogenesis, clinical features, diagnosis and treatment advancements.

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Abbreviations

AEs:

Adverse events

BCG:

Bacillus Calmette-Guerin

CKD:

Chronic kidney disease

CXCL9:

C-X‑C motif chemokine ligand 9

CXCL10:

C-X‑C motif chemokine ligand 10

EMB:

Ethambutol

ESRD:

End-stage renal disease

HD:

Hemodialysis

IGRA:

Interferon-gamma release test

INH:

Isoniazid

MTB:

Mycobacterium tuberculosis

LTBI:

Latent tuberculosis infection

PD:

Peritoneal dialysis

PDGFF-BB:

Platelet derived growth factor-BB

PMNL:

polymorphonuclear leukocytes

PZA:

Pyrazinamide

QFT-GIT:

QuantiFERON-TB Gold In-Tube

RFT:

Rifapentine

RIF:

Rifampicin

TB:

Tuberculosis

TLR:

Toll-like receptors

T‑SPOT:

T‑SPOT.TB test

TST:

Tuberculin (purified protein derivative-PPD) skin test

WHO:

World Health Organization

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Funding

This work was supported by the National Natural Science Foundation of China (No. 81970583 & 82060138), and the Nature Science Foundation of Jiangxi Province (No. 20181BAB205016 & 20202BABL206025).

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  1. Department of Nephrology, the Second Affiliated Hospital, Nanchang University, Nanchang, China

    Xuehan Zhang MD & Gaosi Xu PhD

  2. The Second Affiliated Hospital, Nanchang University, Nanchang, China

    Pingshan Chen MD

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Xuehan Zhang and Pingshan Chen performed the data analysis, wrote the manuscript, and reviewed articles. Gaosi Xu devised the study and revised the manuscript. All authors have read and approved the manuscript.

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Correspondence to Gaosi Xu PhD.

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X. Zhang, P. Chen and G. Xu declare that they have no competing interests.

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Zhang, X., Chen, P. & Xu, G. Update of the mechanism and characteristics of tuberculosis in chronic kidney disease. Wien Klin Wochenschr 134, 501–510 (2022). https://doi.org/10.1007/s00508-022-02009-y

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