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This narrative review synthesizes evidence across pre-dialysis CKD, dialysis, and kidney transplantation to propose a pragmatic care pathway. In advanced CKD, the tuberculin skin test performs poorly, whereas interferon-\u03b3 release assays (IGRAs) are preferred. Screening should be risk-targeted in pre-dialysis CKD, systematic at dialysis initiation, and mandatory pre-transplant for candidates and living donors. Following a positive test, clinicians must exclude active tuberculosis via clinical assessment and chest imaging before starting preventive therapy. Short-course rifamycin-based regimens (4\u202fmonths of daily rifampin [4R], 3\u202fmonths of once\u2011weekly isoniazid plus rifapentine [3HP], or 3\u202fmonths of daily isoniazid plus rifampin [3HR]) enhance completion rates compared with 9\u202fmonths of daily isoniazid (9H). In transplant recipients, rifamycin interactions with calcineurin and Mammalian target of rapamycin (mTOR) inhibitors typically favor 9H; rifamycins demand expert multidisciplinary management with intensive therapeutic drug monitoring. Programmatic data from dialysis units show high completion with tolerable toxicity, affirming routine feasibility. We integrate IGRA-based screening at critical transitions with tailored regimen selection, pyridoxine coadministration for isoniazid, and structured safety monitoring. Priorities include validating novel\n                    <jats:italic toggle=\"yes\">Mycobacterium tuberculosis<\/jats:italic>\n                    antigen-based skin tests in CKD and developing implementation strategies to standardize renal care. We delineate setting-specific approaches for high- versus low-burden countries, addressing subclinical and incipient TB challenges in high-burden contexts. Adopting this framework can curb active TB progression, safeguard grafts, and enhance patient outcomes.\n                  <\/jats:p>","DOI":"10.1128\/cmr.00353-25","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:00:22Z","timestamp":1776690022000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":1,"title":["Management of latent tuberculosis infection in patients with kidney disease"],"prefix":"10.1128","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2965-146X","authenticated-orcid":true,"given":"Wiwat","family":"Chancharoenthana","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01znkr924","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University","place":["Bangkok, 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