title: Epidemiology of tuberculosis cases with end-stage renal disease, California, 2010.
abstract: OBJECTIVE
  Few studies have compared population-based tuberculosis (TB) incidence rates by end-stage renal disease (ESRD) status. No studies have compared TB genotypes by ESRD status to determine whether TB disease resulted from recent transmission or reactivation of latent TB infection (LTBI). We calculated TB incidence rates and compared demographic and clinical characteristics and genotypes among TB cases by ESRD status.
  
  
  METHODS
  This analysis was based on prospective surveillance for TB cases during 2010 in California. Clustered genotype was defined as ≥2 culture-positive TB cases with matching genotypes in the same county. The χ(2) or Wilcoxon rank-sum test was used to compare variables.
  
  
  RESULTS
  During 2010, 83 TB cases with ESRD and 2,244 cases without ESRD were reported in California; TB incidence rates were 110.3/100,000 and 6.0/100,000, respectively. ESRD case patients versus patients without ESRD were more likely to be older (median age 66 vs. 49 years; p < 0.001), foreign-born persons who had arrived in the USA >5 years before TB diagnosis (97 vs. 75%; p < 0.001) and dead at TB diagnosis (7 vs. 2%; p = 0.01). ESRD patients were less likely to have a positive tuberculin skin test (50 vs. 80%; p < 0.001), positive acid-fast bacilli sputum smears (33 vs. 53%; p = 0.01) and cavities on chest radiography (6 vs. 21%; p = 0.01). No differences in proportions of clustered TB genotypes were detected (20 vs. 23%; p = 0.54).
  
  
  CONCLUSIONS
  Rates of TB are 18 times higher in California's ESRD population, and TB disease likely occurred due to LTBI reactivation because few patients had clustered genotypes. Efforts to prevent TB among ESRD patients may require the use of newer diagnostic tests and promotion of LTBI treatment.
authors.affiliation: Tuberculosis Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, Calif., USA.
authors.forename: Amit S
authors.initials: AS
authors.lastname: Chitnis
authors.forename: Gisela F
authors.initials: GF
authors.lastname: Schecter
authors.forename: Martin
authors.initials: M
authors.lastname: Cilnis
authors.forename: Katherine
authors.initials: K
authors.lastname: Robsky
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Flood
authors.forename: Pennan M
authors.initials: PM
authors.lastname: Barry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000235:genetics; D011159:Population Surveillance; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D055815:Young Adult