Abstract
BackgroundWhile there has been a recent epidemiological and clinical focus on the interaction between diabetes and tuberculosis, the interaction between chronic kidney disease and tuberculosis has been less studied. In particular, little is known of the effect of eGFR levels well above that seen in end stage kidney disease on mortality.MethodsWe conducted a retrospective cohort study of 653 adults from a large Australian hospital network, using data from a state-wide registry of reported tuberculosis cases between 2010 and 2018, with ascertainment of diabetes status and renal function data from hospital medical records and laboratory data. Cox proportional hazards regression models were used to calculate hazard ratios for all-cause mortality associated with categories of chronic kidney disease in adults with tuberculosis disease.ResultsTotal number of deaths was 25 (3.8%). Compared to tuberculosis cases with eGFR ≥ 60 ml/min, all-cause mortality was higher for those with chronic kidney disease from an eGFR level of 45 ml/min. The association was independent of sex, age and diabetes status with adjusted hazard ratio of 4.6 (95% CI: 1.5, 14.4) for eGFR 30–44 ml/min and 8.3 (95% CI: 2.9, 23.7) for eGFR < 30 ml/min.ConclusionsOur results suggest a notably increased risk of all-cause mortality even in those with more moderate degrees of renal impairment, in a low tuberculosis prevalence setting. The impact of these findings on a population basis are at least as significant as that found with diabetes and warrant further investigation in populations with higher tuberculosis prevalence.
Highlights
While there has been a recent epidemiological and clinical focus on the interaction between diabetes and tuberculosis, the interaction between chronic kidney disease and tuberculosis has been less studied
This study found that within a cohort of adults with TB disease in a low TB prevalence setting, with 12.6% having diabetes and just under 7.9% being identified with chronic kidney disease (CKD) defined as an eGFR less than 60 ml/min, renal impairment was very strongly associated with all-cause mortality
This study has demonstrated a strong association between CKD and all-cause mortality, the hazard ratio ranging from 4.6 to 8.3 with increasing severity of CKD, greater than that seen for the association between CKD and the development of TB disease in the previously published studies
Summary
While there has been a recent epidemiological and clinical focus on the interaction between diabetes and tuberculosis, the interaction between chronic kidney disease and tuberculosis has been less studied. The interaction of diabetes and TB in relation to the presentation and outcomes of both conditions has been a focus of a number of epidemiological and clinical studies in the last decade. People requiring dialysis are known to be at a significantly increased risk of infection, including TB [1]. This has been attributed to associated immune dysfunction, as well as shared negative socio-economic factors and clinical co-morbidities, including diabetes [2]. The relative impact of dialysis on TB infection and disease is complicated by the association of diabetes with end stage renal disease, there is relatively little published data to allow disaggregation of the relative impact of these conditions
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