Increased risk of active tuberculosis following acute kidney injury: a nationwide, population-based study.
BACKGROUND
Profound alterations in immune responses associated with uremia and exacerbated by dialysis increase the risk of active tuberculosis (TB). Evidence of the long-term risk and outcome of active TB after acute kidney injury (AKI) is limited.


METHODS
This population-based-cohort study used claim records retrieved from the Taiwan National Health Insurance database. We retrieved records of all hospitalized patients, more than 18 years, who underwent dialysis for acute kidney injury (AKI) during 1999-2008 and validated using the NSARF data. Time-dependent Cox proportional hazards model to adjust for the ongoing effect of end-stage renal disease (ESRD) was conducted to predict long-term de novo active TB after discharge from index hospitalization.


RESULTS
Out of 2,909 AKI dialysis patients surviving 90 days after index discharge, 686 did not require dialysis after hospital discharge. The control group included 11,636 hospital patients without AKI, dialysis, or history of TB. The relative risk of active TB in AKI dialysis patients, relative to the general population, after a mean follow-up period of 3.6 years was 7.71. Patients who did (hazard ratio [HR], 3.84; p<0.001) and did not (HR, 6.39; p<0.001) recover from AKI requiring dialysis had significantly higher incidence of TB than patients without AKI. The external validated data also showed nonrecovery subgroup (HR = 4.37; p = 0.049) had high risk of developing active TB compared with non-AKI. Additionally, active TB was associated with long-term all-cause mortality after AKI requiring dialysis (HR, 1.34; p = 0.032).


CONCLUSIONS
AKI requiring dialysis seems to independently increase the long-term risk of active TB, even among those who weaned from dialysis at discharge. These results raise concerns that the increasing global burden of AKI will in turn increase the incidence of active TB.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Vin-Cent
VC
Wu
Chen-Yi
CY
Wang
Chih-Chung
CC
Shiao
Chia-Hsui
CH
Chang
Hui-Yu
HY
Huang
Tao-Min
TM
Huang
Chun-Fu
CF
Lai
Meng-Chun
MC
Lin
Wen-Je
WJ
Ko
Kwan-Dun
KD
Wu
Chong-Jen
CJ
Yu
Chin-Chung
CC
Shu
Chih-Hsin
CH
Lee
Jann-Yuan
JY
Wang
D058186:Acute Kidney Injury / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000473:pathology
D000995:Antitubercular Agents