The Link Between Kidney Function, Malnutrition, and TB

• Ventilation and Cleaning: Poor ventilation and inadequate environmental cleaning in health care settings increase the persistence of TB droplets, raising transmission risks.
• Crowded Outpatient Areas: Crowded and poorly ventilated outpatient areas significantly elevate TB transmission risks, especially from unsuspected and untreated cases.
• TB and Renal Failure: Increased TB risk in renal failure patients is due to immune system dysfunction caused by oxidative stress and uremic toxins.
• Dialysis Population Risk: The dialysis population has a high TB risk, with persistent QFT-GIT positivity linked to higher hazard ratios (HR) and future TB development.
• Declining Kidney Function: TB incidence and hazard ratios increase with declining kidney function, particularly from CKD stage 3 onwards, suggesting a need for targeted TB prevention in advanced CKD stages.
• LTBI Screening: LTBI screening is highly recommended for end-stage renal disease patients on long-term dialysis, though TB risk in CKD patients not requiring dialysis is less clear.
• Malnutrition and TB: Malnutrition, linked to weakened cell-mediated immunity, increases the risk of TB and the progression from latent to active disease.
• Poverty and TB: Poverty is a key factor connecting poor nutrition with higher TB risk, as malnutrition and TB rates rise together in impoverished populations.
• NCD Screening Integration: Integrating NCD screening within TB contact tracing can improve resource efficiency and early detection of comorbidities like diabetes (DM), especially among household contacts of TB patients, who may have higher NCD prevalence than the general population.

Read more here: TB TW ID

References:

1.     Pan, S.C., Chen, C.C., Chiang, Y.T., Chang, H.Y., Fang, C.T. and Lin, H.H., 2016. Health care visits as a risk factor for tuberculosis in Taiwan: a population-based case–control study. American journal of public health, 106(7), pp.1323-1328.

2.     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.

3.     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).

4.     Hamada, Y., Lugendo, A., Ntshiqa, T., Kubeka, G., Lalashowi, J.M., Mwastaula, S., Ntshamane, K., Sabi, I., Wilson, S., Copas, A. and Velen, K., 2024. A pilot cross-sectional study of non-communicable diseases in TB household contacts. IJTLD OPEN, 1(4), pp.154-159.

5.     Cegielski, J.P. and McMurray, D.N., 2004. The relationship between malnutrition and tuberculosis: evidence from studies in humans and experimental animals. The international journal of tuberculosis and lung disease, 8(3), pp.286-298.

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