Drug-induced Hematological, Renal and Hepatic Injuries Among in-patients on Tuberculosis Treatment at Kenyatta National Hospital

Abstract

Introduction: Anti-tuberculosis medications are very toxic with high number of adverse drug reactions (ADRs) that include hematological, renal and hepatic injuries. These ADRs can lead to low rates of treatment compliance, poor treatment outcomes and increased morbidity and mortality rates among the patients. Objective: To determine the prevalence and the risk factors of hematological, renal and liver toxicity among hospitalized adult patients on tuberculosis treatment at Kenyatta National Hospital. Methodology: A retrospective review of files of tuberculosis patients admitted at Kenyatta National Hospital between December 2016 and December 2020 was done. The main outcomes of interest were hematological injuries (anemia, leucopenia, and thrombocytopenia) renal injury and liver toxicity (hepatocellular, cholestatic and mixed injury). Descriptive and inferential data analysis was conducted. Binary logistic regression models were fitted to evaluate factors individually associated with the outcomes. Model building to identify key predictors for toxicity was conducted using a forward stepwise approach then data was analyzed to use STATA version 13 software the statistical tests were carried out at a level of significance of 0.05. Results: Most of the participants were between the age of 31 and 35 years and most were males (74.9%). Almost all the participants (99%) were treated with rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine regimen. The most prevalent comorbidities were diabetes mellitus (14.3%), hypertension (14.3%) and pneumonia (10.7%). The prevalence of pre-treatment anemia was 64.6% while the prevalence post treatment anemia was 74.2%, The prevalence of renal injury was 37.0% after the initiation of tuberculosis treatment and the incidence of kidney injury was 11.6% (n=8) of whom 3 were in stage 1 (risk), 3 were at stage 2(injury) and 2 were in stage 3 (failure) as per the RIFLE grading. Based on the fold elevation of the ALT levels (19.5%) of the patients had some form of liver injury; 6 (7,8%) had mild liver injury while 7(9.1%) had moderate injury and one (1.3%) had severe injury at baseline. Conclusion and Recommendations: Anemia was the most common hematological injury in both the pre and post treatment period. This brings about the need to study the reason as to why most of the tuberculosis patients developed anemia before the initiation of tuberculosis treatment.