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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