Incidence of Tuberculosis Disease and Latent Tuberculosis Infection in Patients with End Stage Renal Disease in an Endemic Region

Abstract

Aim. Patients in chronic renal failure suffer impaired cellular immunity and have an increased risk of tuberculosis (TB). Our aim in this multicenter study was to determine the incidence of TB and to evaluate latent tuberculosis infection (LTBI) in hemodialysis patients. Methods. We retrospectively evaluated the frequency of TB in 779 dialysis patients at 13 hemodialysis centers in five different cities in Southeast Turkey. The tuberculin skin test (TST) was conducted in 733 patients to detect LTBI. Results. The mean age of the patients was 51.2 ± 15.9 years; 398 (51.1%) of the patients were female, and 53.9% of patients had a BCG scar. The mean dialysis duration time was 35.1 ± 33.4 months. TB was diagnosed in 34 cases. The incidence rate of TB in patients undergoing hemodialysis was 3.1%. Ten patients had a history of TB before beginning hemodialysis, and 24 patients had a history of TB after beginning hemodialysis. A diagnosis of TB was made based on clinical data in eight patients and microbiologically or pathologically in 26 patients. The median time between the initiation of dialysis to the diagnosis of TB was 11 months. Extrapulmonary TB occurred in 45.8% of cases, and the most common site of involvement was the lymph nodes. The TST was positive in 61.8% of TB patients and in 37.5% of those with no history of TB. Conclusions. The incidence of TB is high in hemodialysis patients, and they should be evaluated periodically to exclude insidious infection and reduce morbidity and mortality.

Prevalence of latent tuberculosis and treatment adherence among patients with chronic kidney disease in Campo Grande, State of Mato Grosso do Sul

“…The LTB prevalence detected in this study also differs from that obtained in Minas Gerais, in which the value was 28.5% 37 , and in Turkey, in a study by Ates et al, in which the prevalence was 37.5% 38 . We emphasize that this variation may be related to the burden of TB in each region.…”

“…These results align with those in the study performed in Turkey by Ates et al 38 and with the study of Ribeiro et al 41 , which took place in the interior of São Paulo and included study subjects that had been on hemodialysis for at least three years.…”

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

“…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%).…”

Uncommon Association of Tuberculous Dactylitis and Cutaneous Polyarteritis Nodosa in a Hemodialysis Patient

“…It was found to be 6–25 times higher than in the general population, with mortality rates ranging from 17 to 75% [6]. Ates et al [8] reported that the median time between initiation of dialysis and diagnosis of TB was 11 months, which is consistent with several studies showing a high incidence of TB in the first year of dialysis attributable to poor health in general and compromised host immunity.…”

“…The incidence of TB among patients with advanced chronic kidney disease on dialysis is quite varied worldwide, ranging from 1.6 to 28% [8]. It was found to be 6–25 times higher than in the general population, with mortality rates ranging from 17 to 75% [6].…”