Tuberculosis in Maintenance Dialysis Patients

Abstract

In this investigation, we tried to find the incidence and characteristics of tuberculosis (TB) in dialysis patients previously found only in a small number of cases. We collected the cases of newly diagnosed TB patients in Taiwan during 1997. Simultaneously, all dialysis patients were collected and matched with the TB cases to identify the dialysis patients who had also contracted TB. The annual incidence of the dialysis population was 493.4/100,000, 6.9 times that of the general population (71.1/100,000). The annual incidence for the male dialysis population was 573.3, the incidence was 479.2 for the female dialysis population. The incidence for the general population was 97.1 and 43.7/100,000, respectively. Although the 1-year mortality rate due to TB (1.7 vs. 1.9%, p > 0.05) was similar in both populations, the non-TB mortality was much higher in the dialysis population than that in the general population (25.6 vs. 11.1%, p < 0.05). Finally, the 1-year mortality rate of dialysis patients with TB is 3.3 times higher than that in dialysis patients without TB (27.3 vs. 8.3%, p < 0.05). The findings suggest that uremia modifies the behavior of TB, jeopardizes female and younger dialysis patients, poses a higher risk of extrapulmonary dissemination, and predicts a higher overall mortality.

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

“…Pien et al (23) (2). Admission-related complications are other factors associated mortality (3). The present study observed the development of CHF, nosocominal pneumonia, and gastrointestinal bleeding as complications which are not directly related to TB, during admission highly influenced the outcome.…”

“…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).…”

High Prevalence of Latent Tuberculosis Infection in Dialysis Patients Using the Interferon-γ Release Assay and Tuberculin Skin Test

“…In 2006, Taiwan reported the highest rates of incident and prevalent ESRD requiring hemodialysis in the world at 418 and 2226 per million population, respectively (3). The annual incidence of TB in the Taiwanese dialysis population was 493.4 per 100,000 in 1997, which was 6.9 times higher than that of the general population (71.1 per 100,000) (4). Overall 1-year mortality in dialysis patients with TB was higher than in the general TB population (27.3% versus 13.0%, P Ͻ 0.05), but deaths attributable directly to TB were not different (1.7% versus 1.9%, P Ͼ 0.05) (4).…”

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

“…Decades later, another study showed a signifi cantly increased risk of TB in patients with chronic renal failure who were undergoing dialysis 18 . In cohort studies, the relative risk of TB among such patients was 3.4 to 25.3 times greater than that among the general population [19][20][21][22] .…”