title: The diagnostic accuracy of tests for latent tuberculosis infection in hemodialysis patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Reactivation of latent Mycobacterium tuberculosis infection is an important health concern for patients on hemodialysis because of their immunosuppressed state and in kidney transplant patients receiving immunosuppressive therapy to prevent organ rejection. There are several tests available to determine the presence of latent tuberculosis infection: the tuberculin skin test (TST), QuantiFERON-TB Gold (QFT-G), and T-SPOT.TB. The objective of this study is to evaluate the diagnostic accuracy of these tests in determining latent tuberculosis infection in the hemodialysis population.
  
  
  METHODS
  The study design was a systematic review. We selected studies with adequate information to ascertain test sensitivity or specificity of the TST, QFT-G, and TSPOT.TB with regards to determining latent tuberculosis infection in the hemodialysis population.
  
  
  RESULTS
  One hundred two articles were selected for full review, and 17 were included in the meta-analysis. The TST had a pooled sensitivity of 31% (26%-36%, 95% confidence interval) and specificity of 63% (60%-65%) across eight studies. The QFT-G test had a pooled sensitivity of 53% (46%-59%) and specificity of 69% (65%-72%) across nine studies. The T-SPOT.TB test had a pooled sensitivity of 50% (42%-59%) and specificity of 67% (61%-73%) across three studies.
  
  
  CONCLUSIONS
  The QFT-G and the T-SPOT.TB tests were more sensitive than the TST for diagnosis of latent tuberculosis infection in patients on hemodialysis while offering a comparable level of specificity. This systematic review calls into question the practice of using the TST to screen in this population, especially in patients considered for kidney transplantation.
authors.affiliation: 1 Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. 2 Seven Oaks General Hospital Renal Program, Winnipeg, Canada. 3 Section of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, Canada. 4 Department of Library Services, University of Manitoba, Winnipeg, Canada. 5 Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Ferguson
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.forename: Kerry
authors.initials: K
authors.lastname: Macdonald
authors.forename: Brett
authors.initials: B
authors.lastname: Hiebert
authors.forename: Claudio
authors.initials: C
authors.lastname: Rigatto
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.forename: Souradet
authors.initials: S
authors.lastname: Shaw
authors.forename: Blake
authors.initials: B
authors.lastname: Lerner
authors.forename: Yang
authors.initials: Y
authors.lastname: Xu
authors.forename: Salaheddin
authors.initials: S
authors.lastname: Mahmud
authors.forename: Paul
authors.initials: P
authors.lastname: Komenda
mesh_terms: D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis*; D006435:Renal Dialysis / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D014374:Tuberculin Test