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: = 111). Primary outcomes included incident TB and adverse events attributable to IPT. Results: < 0.001). During IPT, 32 patients (17.6%) developed symptoms of peripheral neuropathy (PNP), of whom 20 (62.5%) resolved fully with increased pyridoxine dosing. PNP was associated with older age and hemodialysis (HD). Liver injury was noted in 6 patients (3.3%), of whom 2 continued IPT successfully. Overall, 17 patients (9.3%) required discontinuation of IPT because of side effects attributed to IPT (PNP = 12, liver injury = 4, and pancreatitis = 1). No deaths were attributed to IPT. 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.