Tuberculosis in dialysis patients in Uruguay
DOI:
https://doi.org/10.29193/RMU.36.2.3Keywords:
TUBERCULOSIS, CHRONIC RENAL INSUFFICIENCY, DIALYSIS, URUGUAYAbstract
Objectives: this study aims to estimate the risk of tuberculosis in patients with renal replacement therapy (RRT) and to analyse the variation of its incidence, clinical presentation and prognosis.
Method: retrospectve study from 1995 to 2013. Data was drawn from the Uruguayan Dialysis Registry and the Honorary Commission for the Fight against Tuberculosis and Prevalent Diseases (CHLA-EP). We analysed diagnosis, clinical presentation, tuberculin tests, evolution and mortality. Likewise, variations in incidence, risk and temporary relation of replacement therapy were studied.
Results: in 18 years, 10,516 patients received chronic dialysis in Uruguay and 13,083 cases of tuberculosis were diagnosed. 1.4% (n= 119) of all cases of tuberculosis during that period were patients in renal replacement theraphy (RRT).
The incidence of tuberculosis in the general population during the period studied was 21 every 100,000 patients/year (cp105) vs. 212 cp105 in RRT. The risk of tuberculosis was 8 times greater in RRT (SIR: 8 IC 95% (6.5; 9.3) patients. Average time of RRT at the time of diagnosis was 4 years (0 a 20), 37.8% of cases occurred in the first two years of RRT. However, incidence increased significantly after 9 years of RRT. Mortality in connection with tuberculosis in the general population was 10.3%, this figure being double in the RRT population (23.5%).
Conclusions: the risk of tuberculosis in RRT is greater and its mortality doubles that of the general population.
References
(2) World Health Organization. Global tuberculosis report 2017. Geneva: WHO, 2017.
(3) World Health Organization. Global tuberculosis report 2014. Geneva: WHO, 2014.
(4) Comisión Honoraria para la Lucha Antituberculosa y Enfermedades Prevalentes. Programa Nacional de Control de la Tuberculosis. Informe año 2018. Montevideo: CHLA-EP, 2018.
(5) Pradhan RP, Katz LA, Nidus BD, Matalon R, Eisinger RP. Tuberculosis in dialyzed patients. JAMA 1974; 229:798-800.
(6) Hussein MM, Mooij JM, Roujouleh H. Tuberculosis and chronic renal disease. Semin Dial 2003; 16(1):38-44.
(7) Min J, Kwon SK, Jeong HW, Han JH, Kim YJ, Kang M, et al. End-stage renal disease and risk of active tuberculosis?: a nationwide population-based cohort study. J Korean Med Sci 2018; 33(53):1-11.
(8) Chonchol M. Neutrophil dysfunction and infection risk in end-stage renal disease. Semin Dial 2006; 19(4):291-6. doi:10.1111/j.1525-139X.2006.00175.x.
(9) Milburn HJ. How should we treat tuberculosis in adult patients with chronic kidney disease? Key messages from the British Thoracic Society Guidelines. Pol Arch Med Wewn 2010; 120(10):417-42.
(10) Ahmed AT, Karter AJ. Tuberculosis in California dialysis patients. Int J Tuberc Lung Dis 2004; 8(3):341-5.
(11) Chou KJ, Fang HC, Bai KJ, Hwang SJ, Yang WC, Chung HM. Tuberculosis in maintenance dialysis patients. Nephron 2001; 88(2):138-43. doi:10.1159/000045974.
(12) Chia S, Karim M, Elwood RK, FitzGerald JM. Risk of tuberculosis in dialysis patients: a population-based study. Int J Tuberc Lung Dis 1998; 2(12):989-91.
(13) Simon TA, Paul S, Wartenberg D, Tokars JI. Tuberculosis in hemodialysis patients in New Jersey: a statewide study. Infect Control Hosp Epidemiol 1999; 20:607-9.
(14) Dobler CC, McDonald SP, Marks GB. Risk of tuberculosis in dialysis patients: a nationwide cohort study. PLoS One 2011; 6(12):1-6.
(15) Pien FD, Younoszai BG, Pien BC. Mycobacterial infections in patients with chronic renal disease. Infect Dis Clin North Am 2001; 15(3):851-76.
