Active tuberculosis in patients undergoing hemodialysis for end-stage renal disease: a 9-year retrospective analysis in a single center.
OBJECTIVE
Tuberculosis (TB) in patients undergoing hemodialysis (HD) for end-stage renal disease (ESRD) is commonly thought to be associated with a very poor prognosis. Moreover, it is difficult to diagnose. This report was designed to describe this condition and to determine the mortality rate and risk factors associated with mortality. In addition, the study evaluated the usefulness of QuantiFERON TB-2G((R)) (QFT-2G).


METHODS
Retrospective study


METHODS
Patients with confirmed TB admitted between January 2001 and May 2009 were retrospectively identified and enrolled. The clinical, radiological, and bacteriological data at the time of admission were recorded. A multivariate analysis was performed to identify the predictive factors for mortality.


RESULTS
A total 19 TB patients (6 females; median age, 73 years) were included. TB occurred in most cases within 1.3 years from the initiation of dialysis. Most patients presented with fever (84.2%) and extrapulmonary TB (57.9%). The mortality rate within 24 weeks of the initiation of TB treatment was 36.8%. The factors associated with mortality were: a short duration of dialysis (HR 8.86, 95% CI 1.03-75.7, p=0.04), and underweight (HR 10.88, 95% CI 1.28-92.6, p=0.02). The sensitivity of QFT-2G, acid-fast smear, and polymerase chain reaction was 50, 80, and 88.2% respectively.


CONCLUSIONS
These data indicate a high incidence of TB in the early stages of HD and a high mortality rate among these patients. The clinical utility of QFT-2G was found to be limited. Hypoalbuminemia might therefore be related to either indeterminate or negative results of QFT-2G.
Nakamura
Hideta
H
Department of Medicine and Prevention and Control of Infectious Diseases, University of the Ryukyus, Okinawa. hnhideta@gmail.com
Tateyama
Masao
M
Tasato
Daisuke
D
Teruya
Hiromitsu
H
Chibana
Kenji
K
Tamaki
Yuichiro
Y
Haranaga
Shusaku
S
Yara
Satomi
S
Higa
Futoshi
F
Fujita
Jiro
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007118:Immunoassay; D016867:Immunocompromised Host; D007372:Interferons / Q000097:blood*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000276:immunology* / Q000382:microbiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D014374:Tuberculin Test; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000276:immunology*
D007372:Interferons