Journal Article

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

Lee, Li-Na, Hsu, Chia-Lin, Wang, Jann-Yuan, Lee, Chih-Yuan, Wu, Vin-Cent, Wang, Jann-Tay, Yang, Feng-Jung, Shu, Chin-Chung, Yu, Chong-Jen

2015

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Albumin / Biological response modifiers / Chronic infection / Chronic kidney failure / Comparative analysis / Cross-Sectional Studies / Dialysis / Female / Glomerular filtration rate / Health aspects / Health care / Health Personnel - statistics & numerical data / Hemodialysis / Humans / Infectious diseases / Interferon / Interferon-gamma Release Tests / Kidney diseases / Kidney transplantation / Kidneys / Latent Tuberculosis - complications / Latent Tuberculosis - epidemiology / Lesions / Logistic Models / Male / Malignancy / Medical personnel / Medical research / Middle Aged / Multivariate Analysis / Nursing / Patients / Physicians / Prevalence / Prevalence studies (Epidemiology) / Public health / Renal Dialysis - statistics & numerical data / Renal failure / Renal function / Renal Insufficiency, Chronic - complications / Renal Insufficiency, Chronic - microbiology / Serum albumin / Taiwan - epidemiology / Tuberculosis / Workers