title: Risk of active tuberculosis in chronic kidney disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  Although the global prevalence of chronic kidney disease (CKD) is increasing, the relationship between CKD and active TB is not well described.
  
  
  OBJECTIVE
  To conduct a systematic review to evaluate active TB risk in CKD populations.
  
  
  METHODS
  We searched Ovid Medline, EMBASE and Cochrane databases and relevant journals to identify multicentre or regional studies reporting quantitative effect estimates of an association between CKD and active TB. Risk ratios and rate ratios were used as common measures of association. Pooled estimates were generated using a random-effects model.
  
  
  RESULTS
  Of 3406 papers screened, 12 eligible studies were identified with 71,374 end-stage renal disease (ESRD) patients and 560 TB cases. Meta-analysis of adjusted rate ratio data in dialysis populations showed an increased rate of 3.62 (95%CI 1.79-7.33, P < 0.001) compared to the general population, while unadjusted risk ratio data in transplant populations showed an increased risk of 11.35 (95%CI 2.97-43.41) compared to the general population.
  
  
  CONCLUSIONS
  We found consistent evidence of an increased risk of active TB in ESRD compared to the general population. This relationship persisted despite variability in study population, design and renal replacement therapy (RRT) modality. Further research into the role of comorbidities, RRT modality and CKD stage is required to better understand the association between CKD and active TB.
authors.affiliation: Division of Respirology, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Al-Efraij
authors.affiliation: BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Mota
authors.affiliation: BC Centre for Disease Control, Vancouver, British Columbia, Canada; Australasian Cochrane Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Lunny
authors.affiliation: Division of Nephrology, Faculty of Medicine, University of British Columbia, Royal Jubilee Hospital, Victoria, British Columbia, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Schachter
authors.affiliation: Division of Respirology, Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Cook
authors.affiliation: Division of Respirology, Faculty of Medicine, University of British Columbia, Vancouver, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Johnston
mesh_terms: D015897:Comorbidity; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D018570:Risk Assessment; D014376:Tuberculosis / Q000453:epidemiology*