Tuberculin Responsiveness in Hemodialysis Patients

Abstract

Decreased cellular immunity and tuberculin reactivity have been previously documented in hemodialysis patients. Recently, Smirnoff and colleagues (January 1998)1Smirnoff M Patt C Seckler B et al.Tuberculin and anergy skin testing of patients receiving long term hemodialysis..Chest. 1998; 113: 25-27Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar reported increased rate of anergy and tuberculin nonreactivity in this group of patients. We also evaluated tuberculin response and its relation with demographic features, nutritional parameters, and peripheral blood lymphocytes subsets distribution in cross-sectional-controlled study.2Yildiz A Sever MS Yildiz P et al.Tuberculin reactivity in hemodialysis patients [abstract]..Nephrol Dial Transplant. 1997; 12: A148Google Scholar In our study, response to intradermal 5 IU PPD (InterVax Biologicals Limited; Toronto, Canada) was assessed and a second tuberculin test was performed to all tuberculin nonreactor patients for booster effect 1 week later. Twenty-nine hemodialysis patients (17 male, 12 female; mean age 30.9±9.5 years) and 13 healthy control subjects (8 male, 5 female; mean age 29.2±6.4 yrs) were included. The mean time spent on dialysis was 20.5±17.4 mos. Patients who had history of tuberculosis, were HIV-positive, or had history of recent infection were excluded. It was previously reported that nutrition had effect on tuberculin response.3Pesanti EL The negative tuberculin test: tuberculin, HIV, and anergy panels..Am J Respir Crit Care Med. 1994; 149: 1699-1709Crossref PubMed Scopus (66) Google Scholar Body mass index, serum albumin, and cholesterol levels were measured as nutritional parameters. Fourteen of the patients (48%) were tuberculin negative (8 male, 6 female; mean age 34.1 ±11.1 yrs), and 15 (52%) were tuberculin positive (≥5 mm) (9 male, 6 female; mean age 26.8±3.4 yr). Tuberculin reactivity was not related with patients' age, gender, time spent on dialysis, and nutritional parameters. Smirnoff and colleagues1Smirnoff M Patt C Seckler B et al.Tuberculin and anergy skin testing of patients receiving long term hemodialysis..Chest. 1998; 113: 25-27Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar also reported no correlation with any demographic factors regarding anergy and tuberculin reactivity. Peripheral blood lymphocytes immunophenotypic analysis was performed using monoclonal antibodies against to CD3, CD4, CD8, HLADR, CD56, CD16, and CD19 by FACScan flow cytometer (Becton Dickinson; Sparks Glencoe, MD). On comparing tuberculin positive and negative hemodialysis groups in terms of peripheral blood lymphocytes subsets, no significant difference was found. As a result, tuberculin nonreactivity was detected in nearly half of the hemodialysis patients which was similar to recent data.1Smirnoff M Patt C Seckler B et al.Tuberculin and anergy skin testing of patients receiving long term hemodialysis..Chest. 1998; 113: 25-27Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar Age, gender, and time spent on dialysis had no correlation with this reactivity. The tuberculin nonreactive group was not different from the positive group when compared for the percentage of lymphocytes subtypes. We concluded that tuberculin responsiveness in hemodialysis patients cannot be predicted by the distribution of lymphocytes subtypes, and this reactivity is likely to be regulated in situ immune response.