Abstract
BackgroundThe risk of tuberculosis (TB) in patients with impaired kidney function remains unclear by different stages of renal function impairment.MethodsWe retrospectively recruited all patients with kidney function in a tertiary-care referral center from January 2008 to December 2013 and followed them till December 2016. We defined the primary outcome as active TB development and analyzed the impact of kidney function impairment.ResultsDuring the study period, a total of 289,579 patients were enrolled for analysis, and of them, 1012 patients had active TB events in an average of 4.13 years of follow-up. According to kidney function impairment, the incidence rate of TB was similar in patients with no chronic kidney disease (CKD) or stage 1 and stage 2, and it increased apparently at stage 3a (167.68 per 100,000 person-years) to stage 3b, stage 4 and stage 5 (229.25, 304.95 and 349.29 per 100,000 person-years, respectively). In a Cox proportional hazard regression model, the dose response of TB risk among different stages of kidney function impairment increased significantly from CKD stage 3a to stage 5. Patients with long-term dialysis had a hazard ratio of 2.041 (1.092–3.815, p = 0.0254), which is similar to that of stage 4 CKD but lower than that of stage 5.ConclusionIn patients with impaired kidney function, the risk of TB increases from CKD stage 3, and in stage 5, the risk is even higher than that of those receiving dialysis. Further strategies of TB control need to consider this high-risk group.
Highlights
The risk of tuberculosis (TB) in patients with impaired kidney function remains unclear by different stages of renal function impairment
Of the high-risk groups, patients with end-stage renal disease need long-term dialysis is highly recommended for latent TB infection (LTBI) screening [7], but the risk of TB in patients with decreased kidney function, such as chronic kidney disease (CKD) not requiring dialysis, is still unclear
The proportion of patients with active TB development was lower in no CKD or stage 1 and 2, but it became higher in advanced CKD stage 3 to 5 in comparing with those without TB (p < 0.0001)
Summary
The risk of tuberculosis (TB) in patients with impaired kidney function remains unclear by different stages of renal function impairment. In the post-2015 era, WHO suggest the END TB strategy and many frameworks towards TB elimination [6], including to optimize current treatment and to screen high-risk groups for latent TB infection (LTBI) treatment [7]. The WHO suggests a focus on high-risk groups in high or upper-middle income countries when the TB incidence becomes less than 100 per 100,000 person-years [8]. Of the high-risk groups, patients with end-stage renal disease need long-term dialysis is highly recommended for LTBI screening [7], but the risk of TB in patients with decreased kidney function, such as chronic kidney disease (CKD) not requiring dialysis, is still unclear.
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