Tuberculosis with CKD in Ethiopia

A hospital-based prospective cross-sectional study was conducted between January and December 2023 among 381 patients with chronic kidney disease (CKD) attending six selected hospitals across five regions in Ethiopia. These included facilities in Addis Ababa, Dire Dawa, Oromia, Sidama, and Southern Ethiopia. The study aimed to assess TB prevalence, symptomatology, and associated factors among CKD patients.

The study population had a mean age of 45.08 years (ranging from 15 to 90), with males constituting 54.1% of participants. A majority (59.8%) resided in rural areas, over half had no formal education, and more than 80% were married. Notably, 11.8% had a history of cigarette smoking, and 21.8% reported alcohol consumption. About a quarter (24.9%) lived in rooms without windows, indicating poor ventilation, a known risk factor for TB.

All participants reported at least one TB-suggestive symptom, with decreased appetite (89.5%), weight loss (82.4%), and fatigue (76.6%) being the most common. More than two-thirds experienced six or more symptoms. Among those tested, 8.1% had a prior history of TB treatment, and 6.8% were underweight (BMI <18.5 kg/m²). A large majority (94%) were in pre-dialysis stages, with stage 3 CKD being the most common. Only 9.7% had progressed to end-stage renal disease. Elevated serum creatinine was found in 98.2% of participants, and 81.6% reported a history of hospitalization.

TB was diagnosed in 12.9% of the patients, with 10.5% confirmed bacteriologically. Smear-positive TB was detected in 3.7% of cases, while the Xpert MTB/RIF Ultra assay identified TB in 10.5%. Culture-confirmed TB occurred in 7.9%, and an additional 2.4% were diagnosed based on clinical or radiological findings. Most TB cases (67.4%) were pulmonary, while extrapulmonary and disseminated TB each accounted for 16.3%.

TB prevalence was notably higher among individuals aged 25–44, rural residents, smokers, and those living in rooms without windows. Higher TB positivity was also seen in patients reporting night sweats, hemoptysis, or chest pain. In the multivariable logistic regression analysis, factors independently associated with TB included current or past smoking, decreased appetite, night sweats, diabetes mellitus, dipstick-positive albuminuria, short renal follow-up duration (<1 year), low BMI, and being on maintenance hemodialysis.

Overall, this study highlights a significant burden of TB among patients with CKD, emphasizing the need for targeted TB screening and prevention strategies, especially for high-risk subgroups within this vulnerable population.

Source: Alemu, A., Diriba, G., Seid, G., Wondimu, A., Moga, S., Tadesse, G., Haile, B., Berhe, N., Mariam, S.H. and Gumi, B., 2025. Active tuberculosis among patients with presumptive tuberculosis with chronic kidney disease in a high tuberculosis burden country, Ethiopia: a multi-center study. IJID regions, 14, p.100551.