Abstract
BackgroundTuberculosis (TB) remains an important cause of morbidity and mortality in hemodialysis (HD) patients. A gold standard for the diagnosis of latent tuberculosis infection (LTBI) is lacking.ObjectiveThe aim of this study was to compare the diagnostic utility of the QuantiFERON-Tuberculosis Gold (QFT-G) test with the tuberculin skin test (TST) in identifying LTBI in patients with end-stage renal disease (ESRD) on HD.Study designThe present study had a prospective design.Patients and methodsA total of 74 patients with ESRD on HD without active TB and other immunosuppressive conditions were tested for LTBI by the QFT-G test and the TST.ResultsLTBI, as estimated by the QFT-G test and TST, was detected in 35.1 and 13.5% of the HD patients, respectively; 37.8% of patients were positive for the QFT-G test and/or the TST. There was a poor agreement between QFT-G test and TST results in patients with ESRD on HD (QFT-G test vs. TST: κ=0.25, 95% confidence interval=0.12–0.37). TST was positive in 2.7% of patients when the QFT-G test was negative, and it was negative in 24.3% of patients when the QFT-G test was positive. There was no significant difference in duration of HD or creatinine levels between QFT-G-positive and QFT-G-negative patients (P=0.08 and 0.2, respectively). TST-positive patients had a significantly shorter duration of HD and lower creatinine levels than TST-negative patients (P=0.001 and 0.01, respectively).ConclusionIn patients with ESRD and on HD, LTBI cannot be simply ruled out with a negative TST result, but rather a QFT-G test is recommended. Screening and treatment of LTBI should be carried in dialysis patients, aiming to prevent progression to active TB and secondary infection of others.
Highlights
In Egypt, tuberculosis (TB) is an important health problem
latent tuberculosis infection (LTBI), as estimated by the QuantiFERON-Tuberculosis Gold (QFT-G) test and TST, was detected in 35.1 and 13.5% of the HD patients, respectively; 37.8% of patients were positive for the QFT-G test and/or the TST
There was a poor agreement between QFT-G test and TST results in patients with end-stage renal disease (ESRD) on HD (QFT-G test vs. TST: κ=0.25, 95% confidence interval=0.12–0.37)
Summary
In Egypt, tuberculosis (TB) is an important health problem. The reported prevalence of chronic renal failure is 225 patients per million in Egypt [2]. Individuals with latent tuberculosis infection (LTBI) are assumed to have viable TB bacilli in their body. These bacilli are dormant, but have the potential to reactivate and cause disease [3]. According to the WHO, ∼2–3 billion people in the world have LTBI, and 5–15% of them will suffer from reactivation of TB during their life. Tuberculosis (TB) remains an important cause of morbidity and mortality in hemodialysis (HD) patients. A gold standard for the diagnosis of latent tuberculosis infection (LTBI) is lacking
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