The impact on incident tuberculosis by kidney function impairment status
Shu, CC., Wei, YF., Yeh, YC. et al. The impact on incident tuberculosis by kidney function impairment status: analysis of severity relationship. Respir Res 21, 51 (2020). https://doi.org/10.1186/s12931-020-1294-5
LTBI screening is highly recommended for patients with end-stage renal disease on long-term dialysis; however, the TB risk in patients with chronic kidney disease (CKD) not requiring dialysis remains less clear. With the worldwide increase in CKD burden, understanding its correlation with TB infection is gaining importance. The study focused on patients aged ≥20 years from January 2008 to December 2013, using serum creatinine data to estimate kidney function via the MDRD equation, categorizing CKD into stages based on eGFR values. Exclusions were made for patients with active tuberculosis prior to or shortly after initial kidney function assessment and those with short follow-up periods. Incidence of TB among participants was analyzed by average number per 100,000 person-years, with the male gender comprising about 45.3% of the study group. Advanced stages of CKD showed a significant increase in comorbidities such as CHF, stroke, DM, and SLE, whereas obesity was less common in patients with worse kidney function. Older males with underlying diseases like pulmonary disease, GERD, cancer, heart failure, cirrhosis, diabetes, and autoimmune diseases were more likely to develop TB. Incidence and hazard ratios (HR) for TB increased with declining kidney function, especially from CKD stage 3 onwards, suggesting a higher TB risk as kidney function worsens. Although TB risk in CKD stage 5 was approximately two-fold with a 1.4-fold HR compared to those on long-term dialysis, overlapping confidence intervals indicate uncertainty. Recommendations are made for TB prevention to target patients with CKD stage 3 or higher, in line with WHO guidelines for active LTBI screening in dialysis patients.
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