Title: Unraveling the secrets behind the multidrug resistant tuberculosis treatment outcome in chronic renal failure patients requiring hemodialysis: A systematic review

Abstract

Multidrug-resistant/Rifampicin-resistant tuberculosis (MDR/RR TB) is a global concern, with 450,000 new cases and 191,000 deaths in 2021. Objectives: To evaluate the therapeutic outcome of multidrug-resistant TB of the lungs in patients who require hemodialysis in terms of successful treatment (cured and treatment completed) and the associated factors to a favourable outcome. To identify unfavorable treatment outcomes (treatment failed, died, or loss to follow-up) and the underlying associated factors. Scope: Adults (>19 years old) with chronic kidney disease who needed hemodialysis and had microbiologically confirmed multidrug-resistant pulmonary tuberculosis. Methods: Conformed to the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) 2020 Guidelines for this systematic review. Databases: PubMed, Medline, PubMed Central, Science Direct, Public Library of Science (PLOS), and Google Scholar. Results and Discussion: We gathered 21,570 studies from the databases between 2013 and 2023, with 30,062 total participants. Eight eligible studies for review. Diagnostic samples such as sputum and pleural fluid had lower sensitivity rates than tissue samples, leading to delays in diagnosis and treatment and drug resistance. Tuberculosis-infected patients with severe renal disease (eGFR <30 ml/min) had increased morbidity and mortality. DOTS strategy reduced morbidities such as hospitalization, pneumonia, and ICU stay > 7 days except for inotropic drug use, ventilator support > 21 days, and death. Renal-dose adjustment of anti-TB medications significantly reduced these risks. Conclusion: Controlling comorbidities, ensuring early tuberculosis detection and treatment, detecting drug resistance, and ensuring Directly Observed Treatment, Short Course (DOTS) adherence can reduce these risks. Due to their altered drug metabolism, therapeutic drug monitoring guideline is recommended to reduce adverse events and mortality. Additional research is necessary to determine the safety, efficacy, and outcomes of therapeutic regimens in this population with multidrug-resistant pulmonary tuberculosis.