Abstract
BackgroundThe ability to identify individuals at increased risk of developing tuberculosis (TB) has important implications for public health policy and patient care. We conducted a general population historical cohort study in all Australian States and Territories to establish the risk of TB arising in people on chronic hemo- or peritoneal dialysis.Methodology/Principal FindingsCases of TB disease in patients receiving chronic dialysis were identified by record linkage using the Australia & New Zealand Dialysis and Transplant Registry (ANZDATA) and State and Territory TB notification databases 2001 to 2006. Main outcome measure was the relative risk of TB in people on dialysis, adjusted for TB incidence in country of birth, sex, age and indigenous status. A total of 6,276 cases of active TB were reported among 19,855,283 people living in Australia between 2001 and 2006. Among 14,506 patients on dialysis, 37 had a notification for TB disease after commencing dialysis, of whom 28 were culture positive. The incidence of TB was 66.8/100,000/year (95% CI 47.7 to 93.2) among people on dialysis and 5.7/100,000/year (95% CI 5.5 to 5.8) in the general population. The adjusted relative risk (aRR) of TB in people on dialysis was 7.8 (95% CI 3.3 to 18.7), and the aRR of culture positive TB was 8.6 (95% CI 3.9 to 19.3).Conclusions/SignificancePatients on dialysis are at increased risk of TB. The final decision to screen for, and to treat, LTBI in individual dialysis patients will be influenced by a cumulative assessment of the risk of reactivation of TB and by assessment of risk factors for adverse effects of treatment.
Highlights
Treatment of latent tuberculosis infection (LTBI) in high risk groups such as those who are HIV positive or those in whom antiTNFa therapy is to be commenced plays an important role in control of tuberculosis (TB) disease in low-TB incidence settings
The proportion of Australian-born people was lower in the dialysis population compared to the general population
The proportion of dialysis patients who were born in a country with a TB incidence $25/ 100,000 was higher than in the general population
Summary
Treatment of latent tuberculosis infection (LTBI) in high risk groups such as those who are HIV positive or those in whom antiTNFa therapy is to be commenced plays an important role in control of tuberculosis (TB) disease in low-TB incidence settings. Patients with chronic renal failure are potentially a high risk group for TB. Since a number of studies have shown that the risk of TB in patients with chronic renal failure and on dialysis is significantly increased [9]. Population-based cohort studies have described relative risks of TB of 3.4 to 25.3 in dialysis patients compared to the general population [10,11,12,13]. Selection bias was less of a problem in these population-based cohort studies compared to case-control studies, most made no adjustment, or only very limited adjustment, for confounders (Table 1). We conducted a general population historical cohort study in all Australian States and Territories to establish the risk of TB arising in people on chronic hemo- or peritoneal dialysis. Potential confounders Relative Risk is adjusted for none none age, race age stratification by none gender, age none none
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