Successful Therapy of Tuberculosis in Hemodialysis Patients

Abstract

Tuberculosis associated with dialysis was studied at the Artificial Kidney Unit (AKU) in Abha, Saudi Arabia. There were 13 tuberculosis patients out of 270 patients on maintenance hemodialysis from August 1986 to July 1993, a prevalence of 4.8%. Ten (77%) were female and 3 (23%) were male, mean age of 51.23 ± 11.62 years. The main site of tuberculosis was pulmonary in 8 (62%) patients, in contrast to other studies. Mean duration on hemodialysis before diagnosis of tuberculosis was 19.23 ± 14.43 months and mean duration of symptoms prior to diagnosis was 4.54 ± 3.38 weeks. Anorexia, fever and weight loss were the main presenting symptoms. The tuberculin test was negative in all patients. Choice of treatment using three or four drug regimens for 12 and 6 months, respectively, led to full recovery in all patients with no recurrence. Despite earlier reports of high mortality in such a group of patients, it is suggested that awareness of the increased prevalence of tuberculosis in dialysis patients, together with recognition of its unusual presentation, culminated in early diagnosis and treatment with successful outcomes.

Tuberculosis in Active Dialysis Patients in Jeddah

“…However, the incidence of TB as shown by our study and others is considerably higher in dialysis patients than in the general population [2,8,9]. The inci- Al Shohaib/Scrimgeour/Shaerya dence of tuberculosis in this series was higher compared to previously published data [2,5,6], which were not from the Western Region (Jeddah). The Jeddah area is characterized by the presence of many immigrants.…”

“…These infections are acquired either before or after initiation of dialysis, and the latter may be via nosocomial modes of transmission [1]. Tuberculosis (TB) has been reported to be more common in the dialysis population compared to the general population [2]. The wide range of immunological derangements in chronic renal failure have been postulated to be the cause for the increased susceptibility of dialysis patients to tuberculosis [1].…”

Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care

“…In the study of PENNER et al [5], seven of 13 TB patients developed multiorgan failure and six of them died. However, other studies did not find a correlation between mortality and acute renal failure [2,9,26].…”

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

“…The details of the 10 cases examined by QFT-2G are listed in Table 5 Previous studies reported a high frequency of cases of TB discovered in the first year of dialysis (3,4,13,19 HD (HD >1 year) T a b l e 3 . Ra d i o l o g i c a l Cl a s s i f i c a t i o n o f 1 6 P a t i e n t s wi t h P u l mo n a r y T u b e r c u l o s i s …”

“…While some studies have reported a high mortality rate of 17-75% in uremic patients with TB (2,3), several have reported a very favorable outcome, with no mortality, which may be attributed to both an early diagnosis and treatment (4,5). However, making a diagnosis tends to be difficult and delayed since patients commonly present with extrapulmonary involvement and nonspecific symptoms mimicking uremia (6,7).…”