Zhonghua Jie He He Hu Xi Za Zhi. 2022 Oct 12;45(10):996-1008. doi: 10.3760/cma.j.cn112147-20220327-00241.
China is a country with a high burden of chronic kidney disease(CKD) and tuberculosis. Patients with CKD are at increased risk of infection, and the prevalence of CKD is also significantly higher in patients with tuberculosis. The coexistence of the two diseases brings great difficulties for clinical treatment. In this consensus, the general situation, clinical characteristics, metabolic characteristics of anti-tuberculous drugs, and the principles of protocol formulation of such patients were discussed and summarized. When making anti-tuberculosis regimen for patients with chronic renal failure, drugs that metabolized through liver, liver and kidney channels or metabolic pathways other than liver and kidney should be selected as far as possible. Drugs with significant renal toxicity and mainly metabolized by the kidney should be avoided. For CKD patients with mild decrease in GFR (60-89 ml·min·1.73 m), anti-tuberculosis regimen should be carried out according to the national standards and guidelines, without reducing the dose of anti-tuberculosis drugs. For CKD patients with significantly reduced GFR, mainly CKD3b, stages 4-5, and those receiving dialysis, the anti-tuberculosis regimen must be adjusted according to the GFR. For CKD patients with GFR less than 30 ml·min·1.73 m, this consensus also recommended anti-tuberculous regimen for initial, retreated and multi-drug-resistant tuberculosis patients. This consensus aimed to improve clinicians' understanding of CKD complicated with tuberculosis, standardize the clinical treatment, improve the curative effect, and reduce adverse reactions. Data from previous trials of CKD combined with TB treatment are still scarce. We look forward to further investigation and evidence-based medical research on CKD with tuberculosis in the future, and make positive efforts for the control of CKD and tuberculosis in China.
中国是一个慢性肾脏病（CKD）和结核病负担较重的国家。CKD患者感染风险增加，结核病患者中CKD的患病率也显著更高。这两种疾病并存给临床治疗带来了很大困难。本共识讨论并总结了此类患者的总体情况、临床特征、抗结核药物的代谢特点以及方案制定原则。为慢性肾衰竭患者制定抗结核方案时，应尽可能选择经肝脏、肝肾双通道或肝肾以外代谢途径代谢的药物，避免使用肾毒性显著且主要经肾脏代谢的药物。对于肾小球滤过率（GFR）轻度降低（60 - 89 ml·min·1.73 m²）的CKD患者，应按照国家标准和指南进行抗结核治疗，不减少抗结核药物剂量。对于GFR显著降低的CKD患者，主要是CKD3b期、4 - 5期以及接受透析的患者，抗结核方案必须根据GFR进行调整。对于GFR小于30 ml·min·1.73 m²的CKD患者，本共识还推荐了针对初治、复治及耐多药结核病患者的抗结核方案。本共识旨在提高临床医生对CKD合并结核病的认识，规范临床治疗，提高疗效，减少不良反应。此前关于CKD合并结核病治疗试验的数据仍然匮乏。我们期待未来对CKD合并结核病进行进一步的调查和循证医学研究，为中国CKD和结核病的防控做出积极努力。
