Latent Tuberculosis Treatment Cascade in Chronic Kidney Disease Patients: The Vancouver Experience
Bibliographic record
Abstract
Background. Diagnosis and preventative therapy (PT) in patients with latent tuberculosis infection (LTBI) remains a core strategy for tuberculosis (TB) elimination. Much of the current literature on LTBI in patients with end-stage kidney disease (ESKD) has focused on the effectiveness of available screening tools. There is little data on PT in the ESKD population. The objective of this study is to examine treatment regimens, uptake, treatment outcomes, and adverse events of LTBI treatment in ESKD patients in Vancouver, British Columbia. Methods. We conducted a retrospective chart review from 2007 to 2014 from the British Columbia Centre for Disease Control (BCCDC) TB registry. We included all patients identified with ESKD assessed in BCCDC TB clinics. ESKD was defined as any patient with eGFR <15/mL/min//1.73 m2, patients receiving dialysis, and renal transplant recipients. Patients were diagnosed with LTBI via clinical assessment, tuberculin skin test (TST), and/or interferon gamma release assay (IGRA). Results. In total, 618 ESKD patients were assessed at BCCDC clinics; 605 were prospective or current dialysis patients; and 13 were renal transplant recipients. LTBI was diagnosed in 132 patients: 112 patients tested IGRA positive, 17 were TST positive or were offered therapy based on clinical/radiological findings. Of the 132 patients diagnosed with LTBI, 97 (73.5%) initiated LTBI therapy, with 76 patients (78.4%) completing an LTBI treatment course. Of the patients that completed therapy, 59 (60.8%) completed a course of INH, 9 (9.3%) completed a course of RIF, 7 (7.2%) started a course of INH and switched to complete on RIF, and in 9 (9.3%) treatment was ongoing. Of the 10 patients who did not complete treatment 6 (60.0%) patients stopped early due to drug reactions. In total, 30 (30.9%) patients had adverse reactions and 1 (1.0%) had a significant reaction requiring hospitalization. There were no deaths associated with treatment. Conclusion. This case series demonstrates that despite having multiple comorbidities, high rates of adverse reactions, and complicated pharmacotherapies, a high proportion of CKD patients can complete an LTBI treatment course. Further study is required to understand the cost-effectiveness and epidemiological effects of LTBI screening and treatment in this population. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".