Clinical efficacy and pharmacokinetic study of antituberculosis treatment in patients with end-stage renal disease undergoing hemodialysis

Wei Song; Zhao Yang; Yuqian Zhao; Bing Liu; Musong Li; Wei Du; Ning Niu; Jianru Jia

doi:10.2478/abm-2026-0021

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Clinical efficacy and pharmacokinetic study of antituberculosis treatment in patients with end-stage renal disease undergoing hemodialysis

Asian Biomedicine

Volume 20 (2026): Issue 3 (June 2026)

By: Wei Song, Zhao Yang, Yuqian Zhao, Bing Liu, Musong Li, Wei Du, Ning Niu and Jianru Jia

Open Access

|Jun 2026

Abstract

Background

Patients with end-stage renal disease (ESRD) undergoing hemodialysis exhibit a 10–25 times greater risk of tuberculosis (TB), underscoring the urgent need for optimized treatment strategies to improve prognosis.

Objective

The present study evaluates the efficacy and pharmacokinetics of personalized anti-TB dosing in hemodialysis patients with ESRD and TB, to guide treatment optimization.

Methods

This retrospective study included 90 hemodialysis patients with ESRD and TB (2020 – 2024). The control group (n = 45) received conventional anti-TB dosing; the study group (n = 45) received individualized dosing/timing. All received HRZE (isoniazid, rifampicin, pyrazinamide, ethambutol) and high-flux hemodialysis or hemodiafiltration. Efficacy endpoints included sputum conversion (4, 8, and 12 weeks), imaging at 12 weeks, and clinical effectiveness. Blood samples were collected before/during/after/dialysis intervals to calculate C_max, C_min, AUC_0–24, CL, CLDAA, ER, t^½, and adverse reactions.

Result

No significant baseline differences existed between groups (P > 0.05). The study group showed higher sputum conversion rates, 12-week radiographic improvement, and overall effectiveness (P < 0.05). Pharmacokinetic (PK) analysis revealed elevated C_max, C_min, AUC_0–24 for all anti-TB drugs (P < 0.05). Rifampicin clearance was unchanged (P > 0.05), while others decreased (P < 0.05). Half-life shortened on dialysis days (P < 0.01). Adverse reactions were markedly reduced in the study group (P < 0.01).

Conclusions

For hemodialysis patients with ESRD and TB, tailoring anti-TB drug regimens based on PK profiles can enhance efficacy and minimize adverse effects, offering a safe and personalized treatment pathway.

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Articles in this issue

DOI: https://doi.org/10.2478/abm-2026-0021 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

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Language: English

Page range: 182 - 193

Published on: Jun 30, 2026

Published by: Chulalongkorn University

In partnership with: Paradigm Publishing Services

Keywords:

adjustment of dose,

end-stage renal disease,

Related subjects:

Clinical medicine, other,

Medicine,

Basic medical science,

Basic medical science, other,

Medicine,

Assistive professions, nursing

© 2026 Wei Song, Zhao Yang, Yuqian Zhao, Bing Liu, Musong Li, Wei Du, Ning Niu, Jianru Jia, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 20 (2026): Issue 3 (June 2026)