Risk of tuberculosis among patients on dialysis

Shu, C.C., Hsu, C.L., Wei, Y.F., Lee, C.Y., Liou, H.H., Wu, V.C., Yang, F.J., Lin, H.H., Wang, J.Y., Chen, J.S. and Yu, C.J., 2016. Risk of tuberculosis among patients on dialysis: the predictive value of serial interferon-gamma release assay. Medicine, 95(22), p.e3813.


Epidemiology and Diagnostics:

  • Tuberculosis (TB) incidence was reported at 319.1 per 100,000 persons.
  • QuantiFERON-TB Gold In-Tube (QFT-GIT) test had no predictive role for TB.

Risk Factors for TB in Dialysis Patients:

  • Factors such as current smoking, brief dialysis duration, active radiographic lesions, and fever were linked with prevalent TB.
  • Reasons for increased TB risk in individuals with renal failure include enhanced immune cell apoptosis, lymphocyte depletion, and dysfunction of polymorphonuclear leukocytes, all exacerbated by oxidative stress and uremic toxins from the blood.

TB Risk and Management in the Dialysis Population:

  • The dialysis population has a high TB risk; a positive QFT-GIT test indicates a high TB risk despite a 49.6% rate of negative conversion.
  • Persistent positivity in QFT-GIT testing is associated with higher hazard ratio (HR) and specificity for future TB development.

 

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