The value of tuberculin skin testing in haemodialysis patients.
BACKGROUND
Chronic haemodialysis patients are at increased risk for developing tuberculosis (TB). Appropriate screening methods to detect latent Mycobacterium tuberculosis infection are required. The aim of this prospective multi-centre study was to evaluate the tuberculin skin test (TST) as a screening method for detection of M.tuberculosis infection in haemodialysis patients.


METHODS
A total of 224 patients in two haemodialysis centres were prospectively tested, using 2 units of tuberculin PPD RT23. Up to three booster injections were given with a 7 day interval to patients not responding to the previous test. The results were compared with clinical and radiological data.


RESULTS
The cumulative prevalence of a positive TST was 14.7% for the first test, 27.8% for the second test and 32.6% for the fourth test. There was no influence of age, gender, haemodialysis centre, dialysis efficiency, nutritional state, levels of zinc, vitamin D therapy, primary renal disease, (previous or active) immunosuppressive therapy or response to hepatitis B vaccination. There was a significant, but weak, correlation between TST positivity and a history of positive TST or TB. Chest radiography and positive TST were not correlated, yet a positive chest X-ray increased the detection of patients with latent M.tuberculosis infection up to 47.8%.


CONCLUSIONS
In haemodialysis patients, a positive response of >30% to repeated TST was obtained. Two consecutive TSTs were sufficient to recruit most of the booster reactions. Since only a weak correlation was found with anamnestic data, regular TST evaluation in combination with a chest X-ray, is a useful tool to detect infection with M.tuberculosis in haemodialysis patients.
Wauters
Anne
A
Division of Nephrology, Department of Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Peetermans
Willy E
WE
Van den Brande
Paul
P
De Moor
Bart
B
Evenepoel
Pieter
P
Keuleers
Hilde
H
Kuypers
Dirk
D
Stas
Koen
K
Vanwalleghem
Johan
J
Vanrenterghem
Yves
Y
Maes
Bart D
BD
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001530:Belgium / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D015203:Reproducibility of Results; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D014374:Tuberculin Test; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology