Active Tuberculosis in Patients Undergoing Hemodialysis for End-stage Renal Disease: A 9-year Retrospective Analysis in a Single Center

Nakamura, Hideta; Tateyama, Masao; Tasato, Daisuke; Teruya, Hiromitsu; Chibana, Kenji; Tamaki, Yuko; Haranaga, Shusaku; Yara, Satomi; Higa, Futoshi; Fujita, Jiro

doi:10.2169/internalmedicine.48.2660

Cited by 12 publications

(16 citation statements)

References 29 publications

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“…In our cohort, the lungs were the commonest site followed by lymph node disease. Similarly, as reported in studies from India, Saudi Arabia, Taiwan, Japan, and Spain [18][19][20][21][22] , the incidence of extra-pulmonary TB was relatively high in patients with CKD. We were unable to find any UK data for comparison.…”

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confidence: 68%

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Incidence of tuberculosis is high in chronic kidney disease patients in South East England and drug resistance common

et al. 2016

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The risk of tuberculosis (TB) is significantly increased in chronic kidney disease (CKD). Data on TB in CKD in the UK are sparse; most information stems from countries with high background prevalence. The aim of this study was to estimate the incidence of TB in CKD patients in South East London and to describe the epidemiology, treatment, and outcome. CKD patients with TB between 1994 and 2010 were identified retrospectively. Data were collected on type of renal replacement therapy, the method of TB diagnosis, disease site, treatment regimens, and risk factors. Forty patients were identified of whom 67.5% had CKD stages IV-V. Sixty-five percent were from non-UK born ethnic minorities. Median time from diagnosis of CKD to TB development was 12 months (range 0-192 months). Cumulative incidence of TB was 1267/100,000 [95% confidence interval (CI): 630-1904; 85 Â background UK rate] in hemodialysis patients; 398/100,000 (95% CI: 80-1160; 26 Â background UK rate) in peritoneal dialysis; and 522/100,000 (CI: 137-909; 35 Â background UK rate) in transplant recipients. Sixty-three percent of patients had pulmonary TB and 25% of patients with culture-positive TB had resistant isolates. Fifty percent of patients were immunosuppressed due to drugs, diabetes, and/or retroviral disease. Treatment regimens were according to recent national guidance in 73% of cases. Seventy-six percent of patients experienced side effects. Greater awareness of risk factors, drug resistance, treatment regimens, and potential side effects is needed. ARTICLE HISTORY

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confidence: 68%

“…This has been reported before. 20,23 The rate of drug resistance to any first-line anti-TB agent (23.8%) was three times higher than the UK figures for 2013 (7.8%) 8 and twice as high as the London rate of 10.5%. 16 UK data suggest that the proportion of resistance to first-line drugs is highest in those from Eastern Europe (37%), followed by SE Asia (12.2%).…”

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confidence: 91%

Incidence of tuberculosis is high in chronic kidney disease patients in South East England and drug resistance common

et al. 2016

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“…We experienced a case of disseminated TB in a hemodialysis patient that was only detected at autopsy. The findings of the present case are consistent with the high incidence of TB during the early stages of hemodialysis reported previously [5], emphasizing the importance of screening for this infection in such patients.…”

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confidence: 92%

A case of disseminated tuberculosis after the initiation of hemodialysis

Hasegawa

Wakai

2013

CEN Case Rep

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A 67-year-old man with diabetes mellitus, chronic kidney disease, chronic heart failure, and amputation of the left lower limb was admitted to our hospital with decreasing renal function. On admission, he was started on hemodialysis. He simultaneously developed a urinary tract infection, infected necrotic wound of the right lower limb, and pneumonia, and was treated with broad-spectrum antibiotics. Although his general condition improved, fever and anorexia persisted and jaundice worsened. He died 138 days after admission. Autopsy revealed granulomas in the lungs, liver, and spleen. Cultures revealed Mycobacterium tuberculosis, leading to the diagnosis of disseminated tuberculosis.

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“…However, the risk-factors contributing to mortality have been discussed in a recent article. [13] A shorter duration of hemodialysis and being underweight were found to be significant risk-factors. The state of malnutrition and depressed cellular immunity are more severe in the early stages of maintenance hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis in haemodialysis patients: A single centre experience

Rao¹,

Ram²,

Swarnalatha³

et al. 2013

Indian J Nephrol

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We prospectively followed-up new patients of tuberculosis while on maintenance hemodialysis at a State Government-run tertiary care institute. Between 2000 and 2010, 1237 new patients were initiated on maintainence hemodialysis. The number of patients diagnosed with tuberculosis after initiation of hemodialysis was 131 (10.5% of 1237). The age was 46.4 ± 10.4 (range 8-85) years and there were 90 (68.7%) males. The number of patients diagnosed with tuberculosis on the basis of organ involvement were: Pulmonary-60, pleural effusion-31, lymph node-21, meningitis-8, pericardial effusion-7, peritoneum-2, latent tuberculosis-2. The incidence of tuberculosis in hemodialysis was found to be 105.9 per 1000 patient years. Male gender, diabetes mellitus, past history of tuberculosis, mining as an occupation, low serum albumin, and duration of hemodialysis more than 24 months, and unemployment were found to be significant risk-factors on univariate analysis.

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Active Tuberculosis in Patients Undergoing Hemodialysis for End-stage Renal Disease: A 9-year Retrospective Analysis in a Single Center

Cited by 12 publications

References 29 publications

Incidence of tuberculosis is high in chronic kidney disease patients in South East England and drug resistance common

Incidence of tuberculosis is high in chronic kidney disease patients in South East England and drug resistance common

A case of disseminated tuberculosis after the initiation of hemodialysis

Tuberculosis in haemodialysis patients: A single centre experience

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