Comparison of the Prevalence of Latent Tuberculosis Infection among Non-Dialysis Patients with Severe Chronic Kidney Disease, Patients Receiving Dialysis, and the Dialysis-Unit Staff: A Cross-Sectional Study.
BACKGROUND
Patients with renal failure are vulnerable to tuberculosis, a common worldwide infectious disease. In the growing dialysis population, the risk for tuberculosis among the associated sub-groups is important but unclear. This study investigated latent tuberculosis infection (LTBI) in patients with severe chronic kidney disease (CKD) and among dialysis-unit staff caring for patients on dialysis.


METHODS
From January 2012 to June 2013, patients undergoing dialysis, those with severe CKD (estimated glomerular filtration rate <30 ml/min/1.73 m2), and the dialysis-unit staff (nursing staff and doctors in hemodialysis units) in several Taiwan hospitals were prospectively enrolled. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine LTBI. Predictors for LTBI were analyzed.


RESULTS
Of the 599 participants enrolled, 106 (25%) in the dialysis group were IGRA positive. This was higher than the seven (11%) among severe CKD patients and 12 (11%) in the dialysis-unit staff. Independent predictors of LTBI in patient with renal dysfunction were old age (odds ratio [OR]: 1.03 [1.01-1.04] per year increment), prior TB lesion on chest radiograph (OR: 2.90 [1.45-5.83]), serum albumin (OR: 2.59 [1.63-4.11] per 1 g/dl increment), and need for dialysis (OR: 2.47, [1.02-5.95]). The QFT-GIT response was similar among the three groups. Malignancy (OR: 4.91 [1.84-13.10]) and low serum albumin level (OR: 0.22 [0.10-0.51], per 1 g/dl decrease) were associated with indeterminate IGRA results.


CONCLUSIONS
More patients on dialysis have LTBI compared to those with severe CKD and the dialysis-unit staff. Old age, prior radiographic TB lesion, high serum albumin, and need for dialysis are predictors of LTBI in patients with renal failure. Patients with severe CKD are a lower priority for LTBI screening. The hemodialysis environment is not a risk for LTBI and dialysis-unit staff may be treated as general healthcare workers.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan; School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Traumatology, National Taiwan University Hospital, Taipei City, Taiwan.
Chin-Chung
CC
Shu
School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Chia-Lin
CL
Hsu
Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
Chih-Yuan
CY
Lee
School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Jann-Yuan
JY
Wang
School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Vin-Cent
VC
Wu
Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan.
Feng-Jung
FJ
Yang
School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Jann-Tay
JT
Wang
School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Chong-Jen
CJ
Yu
School of Medicine, National Taiwan University, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Li-Na
LN
Lee
D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D059425:Interferon-gamma Release Tests; D055985:Latent Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000382:microbiology*; D013624:Taiwan / Q000453:epidemiology