SUN-276 REEMERGING PROBLEM OF TUBERCULOSIS IN CHRONIC KIDNEY DISEASE PATIENTS: VIGILANCE NEEDED

Abstract

Tuberculosis (TB) is an important public health problem in India. There are limited data on TB among chronic kidney disease (CKD) population from Indian subcontinent. The diagnosis of TB in CKD patients is difficult due to suboptimal performance of screening and diagnostic tests. This study investigates the clinical profile and outcome of TB in CKD patients This was a prospective observational study over a period of 5 years (2013- 2018) with 6 months follow up. The diagnosis of tuberculosis was done on the basis of clinical and laboratory data. The anti-Koch’s treatment (AKT) was started and modified as per renal function. TB was diagnosed in twenty-seven CKD patients. The AKT regime, drug related adverse effects and outcome were noted. Mean age of the patients was 47.4 ±16.2 years. The majority of the patients (74%) were male. Most of the patients (74%) were in CKD stage 5D followed by five patients (18.5%) were having CKD stage 4 and only two patients (7.5%) having CKD stage 3 at the time of diagnosis. The modality of renal replacement therapy was hemodialysis in 25 patients (92.5%) and only two patients (7.5%) were on peritoneal dialysis. Seven patients (25.9%) were already having Diabetes Mellitus at the time of TB diagnosis. Mean duration dialysis at the time of diagnosis of TB was 9.2 ± 10.6 months. Most of the patients (66.6%) had an extrapulmonary involvement. Pleuro-pulmonary (33.3%), lymph node (25.9%), peritoneum (18.5%) followed by genitourinary tract (11.1%) were the common sites for TB. About 7.4% patients had joint TB and one patient (3.7%) had disseminated TB. Predominantly common clinical presentation was: fever/ pyrexia of unknown origin (55.5%), constitutional symptoms of anorexia, night sweats and weight loss (18.5%) and abnormal chest radiograph (22.2%). The diagnosis of TB in 59.3% patients was on the basis of microbiological/histological reports and only on clinical grounds in rest of the 40.7% patients. Fourteen patients (40.7%) had adverse effects related to AKT. Particularly, nine patients (33.3%) had accelerated hypertension related to rifampicin induced enzyme induction of anti-hypertensive and three patients (11.1%) had isoniazide induced cerebellitis which required dose modification, and two (7.4%) had hepatitis. About 70.3% of the patients survived, and 29.6% died. The clinical presentations of TB in CKD patients are mostly nonspecific, leading to delay in diagnosis and treatment, which is a major factor for poor outcome. Extrapulmonary TB is more common in CKD patients, which needs high index of suspicion. The adverse effects of AKT complicate the treatment and needs vigilance from physician’s perspectives.