Prevalence of latent tuberculosis infection and risk of infection in patients with chronic kidney disease undergoing hemodialysis in a referral center in Brazil

Abstract

OBJECTIVE: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center. METHODS: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion. RESULTS: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%. CONCLUSIONS: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

Prevalence of latent tuberculosis and associated factors in patients with chronic kidney disease on hemodialysis

“…We recorded a low prevalence of latent TB among patients with CKD on hemodialysis (8.5%), when compared to other international and national surveys. A study conducted in Taiwan (9) reported a prevalence of 11%, very close to another study carried out in Brazil (5) , which recorded a prevalence of 11.2% in the same conditions.…”

“…We recorded a low prevalence of latent TB among patients with CKD on hemodialysis (8.5%), when compared to other international and national surveys. A study conducted in Taiwan 9 reported a prevalence of 11%, very close to another study carried out in Brazil 5 , which recorded a prevalence of 11.2% in the same conditions. Among the predictive factors for latent TB, we highlight the presence of pre-existing comorbidities (diabetes mellitus ) and socio-sanitary conditions (garbage collection).…”

“…In these patients, uremia reduces the expression of the co-stimulatory B7-2 molecule in cells presenting the antigen, which alters the function of the polymorphonuclear cells and interferes in the phagocytic, migration, and chemotactic efficiency, reducing the capacity of cells to kill intracellular microorganisms. In patients with CKD on hemodialysis, the risk of developing TB is 6.5 to 52.5 times higher than in the general population 4 - 5 .…”

“…After signing the free and informed consent form, an interview was conducted with the patients. Sociodemographic (socioeconomic and health conditions of the patients) and clinical variables were collected by means of a questionnaire, created and validated for this research, taking into consideration vulnerabilities already consolidated in the literature (5,8) . Copenhagen, Denmark).…”

Prevalence of latent Mycobacterium tuberculosis infection in renal transplant recipients

“… 9 , 10 However, the TST is not performed rigorously at transplant centers in Brazil. 11 , 12 It is of note that there are few published studies on this topic in the country.…”