title: The value of tuberculin skin testing in haemodialysis patients.
abstract: 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.
authors.affiliation: Division of Nephrology, Department of Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Wauters
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.forename: Paul
authors.initials: P
authors.lastname: Van den Brande
authors.forename: Bart
authors.initials: B
authors.lastname: De Moor
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.forename: Hilde
authors.initials: H
authors.lastname: Keuleers
authors.forename: Dirk
authors.initials: D
authors.lastname: Kuypers
authors.forename: Koen
authors.initials: K
authors.lastname: Stas
authors.forename: Johan
authors.initials: J
authors.lastname: Vanwalleghem
authors.forename: Yves
authors.initials: Y
authors.lastname: Vanrenterghem
authors.forename: Bart D
authors.initials: BD
authors.lastname: Maes
mesh_terms: 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