Prevalence of latent tuberculosis and associated factors in patients with chronic kidney disease on hemodialysis.

Viviane Ferreira,Elen Almeida Romão,Valdes Roberto Bollela,Dulce Aparecida Barbosa,Alvaro Francisco Lopes De Sousa,Jose Abrão Cardeal Da Costa,Cassiane Dezoti Da Fonseca

doi:10.1590/1518-8345.3839.3442

Abstract

Objective:to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors.Method:a cross-sectional study conducted with 176 patients with chronic kidney disease on hemodialysis. The tuberculin test was performed with the standardized antigen, distributed by the Brazilian Ministry of Health, and the reading occurred after 72 to 96 hours of the application. An association test (Chi-square, Fisher’s exact), prevalence ratio, and multivariate regression tests were performed.Results:the prevalence of latent tuberculosis diagnosed through Tuberculosis Skin Test was 8.5% (15/176). The “has/has had diabetes” (aOR: 0.117; 95%CI: 0.015-0.92) and “having regular garbage collection (aOR: 0.076; 95%CI: 0.008-0.702) factors were associated with a lower probability of having a Positive skin test.Conclusion:the low prevalence of latent tuberculosis identified and the factors associated with it reinforce the need for screening for latent tuberculosis infection for diabetics combined with an analysis of previous risk factors and comorbidities.

Highlights

MethodTuberculosis (TB) is still a severe public health problem worldwide, being among the 10 main causes of death[1]
Considering that the strategies in the identification of chronic kidney patients carriers of the latent form of the Koch’s bacillus are still incipient and the fact of Brazil being an endemic country of this disease in the world, we aim to identify the prevalence of latent tuberculosis in patients with chronic kidney disease on hemodialysis and associated factors
We considered the total population of patients with terminal Chronic Kidney Disease (CKD) on hemodialysis kidney replacement therapy, assisted in this period, including patients successively in the research, once they met the inclusion criteria: patients from both gender, aged 18 years old or older

Summary

Introduction

MethodTuberculosis (TB) is still a severe public health problem worldwide, being among the 10 main causes of death[1]. Official data from the World Health Organization[1,2] report that nearly 10 million people in the world have fallen ill with TB every year and that more than 1.5 million have died from the disease in 2018. Patients with some type of immunosuppression, such as those with Chronic Kidney Disease (CKD), are more susceptible to TB infection[4]. In these patients, uremia reduces the expression of the co-stimulatory B7-2 molecule in cells presenting the antigen, which alters the function of the polymorphonuclear cells and interferes in the phagocytic, migration, and chemotactic efficiency, reducing the capacity of cells to kill intracellular microorganisms. In patients with CKD on hemodialysis, the risk of developing TB is 6.5 to 52.5 times higher than in the general population[4,5]

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Discussion

Conclusion