title: Tuberculosis and chronic kidney disease: an emerging global syndemic.
abstract: The link between chronic kidney disease (CKD) and tuberculosis (TB) has been known for more than 40 years, but the interaction between these 2 diseases is still poorly understood. Dialysis and renal transplant patients appear to be at a higher risk of TB, in part related to immunosuppression along with socioeconomic, demographic, and comorbid factors. Meanwhile, TB screening and diagnostic test performance is suboptimal in the CKD population, and there is limited evidence to guide protocols. Given the increasing prevalence of CKD in TB endemic areas, a merging of CKD and TB epidemics could have significant public health implications, especially in low- to middle-income countries such as India and China, that are experiencing rapid increases in CKD prevalence and account for more than one-third of global TB prevalence. To begin addressing TB-CKD, a clear understanding of the relationship between these 2 conditions needs to be established, and consistent, evidence-based screening and treatment guidelines need to be developed.
authors.affiliation: Faculty of Medicine, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kamila
authors.initials: K
authors.lastname: Romanowski
authors.affiliation: University of Ottawa, Ottawa Hospital Research Institute, Kidney Research Centre, and Division of Nephrology, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Clark
authors.affiliation: Faculty of Medicine, Division of Nephrology, University of British Columbia and British Columbia Provincial Renal Agency, St. Paul's Hospital, Centre for Health Evaluation and Outcomes Research, Vancouver, British Columbia, Canada.
authors.forename: Adeera
authors.initials: A
authors.lastname: Levin
authors.affiliation: Faculty of Medicine, Division of Respirology, University of British Columbia and TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Cook
authors.affiliation: Faculty of Medicine, Division of Respirology, University of British Columbia and TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. Electronic address: james.johnston@bccdc.ca.
authors.forename: James C
authors.initials: JC
authors.lastname: Johnston
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D002986:Clinical Trials as Topic; D015897:Comorbidity; D019353:Endemic Diseases / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007194:India / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008403:Mass Screening; D009395:Nephritis, Interstitial / Q000139:chemically induced; D017410:Practice Guidelines as Topic; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology* / Q000628:therapy; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000995:Antitubercular Agents
keywords: chronic kidney disease; dialysis; global burden of disease; kidney transplant; tuberculosis