Tuberculosis in dialysis patients: a nine-year retrospective analysis

Abstract

Introduction: Diagnosis of tuberculosis (TB) among dialysis patients may be difficult because of increased frequency of extra-pulmonary presentations, atypical clinical manifestations, and non-specific symptoms. This study aimed to investigate the spectrum of clinical presentations and outcome in dialysis patients during a nine-year period. Methodology: A total of 651 patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) for at least three months in our unit between 2001 and 2010 were studied. Dialysis and follow-up were performed in our tertiary care center located in the eastern region of Turkey. Diagnosis of TB was established by combining clinical, radiological, biochemical, microbiological, and histological findings. Choice of anti-TB drug used, the results of therapy, and patient outcome were noted. Results: Out of 651 dialysis patients studied, 322 (49.4%) were on PD and the remainder on HD (50.6%). Twenty-six (4%) of the 651 dialysis patients were diagnosed with TB (15 PD, 11 HD), 5 of whom were diagnosed by microbiological assessment, 9 by pathological assessment, and 12 by clinical and radiological findings. Mean age at diagnosis was 41.5 ± 16.5 years and the female/male ratio was 1.18. Three patients had a history of pulmonary TB. Extra-pulmonary involvement was observed in 17 (65.4%) patients. All patients were treated with rifampicin isoniazid, ethambutol, pyrazinamide and pyridoxine. Four patients died during the study. Conclusion: TB occurred in dialysis patients and extra-pulmonary TB was more commonly identified than pulmonary TB. Tuberculous lymphadenitis was the most frequent form of extra-pulmonary TB in our cohort.

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

“…Extrapulmonary TB was more commonly identifi ed than pulmonary TB, with tuberculous lymphadenitis being the most frequent form 11 .…”

Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions

“…A particularly susceptible group of patients are those with end-stage renal disease (ESRD) receiving maintenance hemodialysis (HD) therapy[2]. The risk for dialysis patients developing TB can be up to 52 times higher than the general population depending on the geographic region [3-5]; the prevalence of TB may range from 1.6% to 5.8% in developed countries and upwards of 28% in some developing countries [4]. The increased disease acquisition in ESRD is likely multifactorial but often attributed to decreased cellular immunity in the uremic state and a higher prevalence of high-risk comorbidities such as advanced age, diabetes, and low body mass index [4,6-10].…”

“…The risk for dialysis patients developing TB can be up to 52 times higher than the general population depending on the geographic region [3-5]; the prevalence of TB may range from 1.6% to 5.8% in developed countries and upwards of 28% in some developing countries [4]. The increased disease acquisition in ESRD is likely multifactorial but often attributed to decreased cellular immunity in the uremic state and a higher prevalence of high-risk comorbidities such as advanced age, diabetes, and low body mass index [4,6-10]. Importantly, survival is limited following TB, with mortality rates ranging from 17% to 75% among dialysis-dependent patients [4,11].…”

“…The increased disease acquisition in ESRD is likely multifactorial but often attributed to decreased cellular immunity in the uremic state and a higher prevalence of high-risk comorbidities such as advanced age, diabetes, and low body mass index [4,6-10]. Importantly, survival is limited following TB, with mortality rates ranging from 17% to 75% among dialysis-dependent patients [4,11]. In this patient group, clinical presentations of pulmonary TB disease may be atypical, given the high prevalence of extrapulmonary disease [12-14].…”

Hallazgos radiológicos de la tuberculosis pulmonar y su correlación con la presencia de cultivo positivo para Mycobacterium tuberculosis

“…Tanto es así que algunos estudios han descrito un mayor porcentaje de casos con TB extrapulmonar en comparación con la forma pulmonar, siendo la linfadenitis tuberculosa la forma más frecuente (76).…”