Safety and Effectiveness of Long-Term Isoniazid Treatment for the Prevention of Tuberculosis in High-Risk Dialysis Patients

Introduction Patients with chronic kidney disease (CKD) receiving dialysis (CKD-5D) are at increased risk for tuberculosis (TB), which significantly heightens the risk of mortality. Long-term isoniazid prevention therapy (IPT) to prevent TB is a promising strategy, although the safety and effectiveness of the approach in this high-risk population is unknown. Methods Between 2019 and 2025, universal long-term IPT was administered to patients with CKD-5D ( N = 182) receiving dialysis in Gqeberha, South Africa (post-IPT cohort), an area with high TB rates. The incidence of TB post-IPT was compared with a historical CKD-5D cohort (pre-IPT) from the same unit ( n = 111). Primary outcomes included incident TB and adverse events attributable to IPT. Results The incidence of TB (per 100,000 person-years [pys]) in the post-IPT cohort was 367, versus 4505 pre-IPT (92% relative risk reduction, P Conclusion Long-term IPT significantly reduced the incidence of TB in a high-risk cohort with CKD-5D. IPT was safe and well-tolerated, with < 10% of patients discontinuing therapy because of adverse events, which were generally mild and reversible. These findings provide strong real-world evidence supporting IPT use in TB-endemic dialysis populations.