Clinical Characteristics and Outcomes in Chronic Kidney Disease Patients with Tuberculosis in China: A Retrospective Cohort Study

Abstract

Background The diverse manifestations of tuberculosis (TB) in chronic kidney disease (CKD) patients can cause difficulty in diagnosis, delayed treatment, even death. Therefore, this study investigated the clinical characteristics and the risk factors for mortality in CKD patients with TB. Methods This retrospective study included 167 patients diagnosed with active TB at two tertiary medical centers in Chongqing within six years. Clinical characteristics and outcomes of anti-TB treatment in patients with and without CKD were collected, and the predictive mortality values of variables were analyzed. Results Of the 167 patients, 66.7% (44/66) hemodialysis (HD), 41.1% (21/51) pre-HD, and 32.0% (16/50) non-CKD patients had extrapulmonary TB. The pleura and lymph node were the common sites in CKD patients. Clinical presentations of cough and hemoptysis in CKD patients were less common than those in non-CKD patients, 13.7% (16/117) of CKD patients even not having any clinical symptoms. The positive rates of tuberculin skin test, TB-polymerase chain reaction and acid-fast bacilli in sputum in HD patients were lower than those in pre-HD and non-CKD patients ( p <0.05). CKD patients were more prone to gastrointestinal and neurological side effects during anti-TB treatment. The mortality rates of non-CKD, pre-HD and HD patients was 6.1%, 31.9% and 37.3%, respectively. Multivariate Cox analysis revealed that age≥40 years (HR: 5.871; p =0.019), hypoalbuminemia (HR:2.879; p =0.004), CKD stage 4–5 (HR:4.719; p =0.018) and HD (HR:6.13; p =0.005) were associated with mortality. Discussion CKD patients with TB have atypical clinical manifestations and high mortality. Age, hypoalbuminemia, CKD stage 4–5, and HD were independent predictors of mortality.

Epidemiology of tuberculosis in Kazakhstan: data from the Unified National Electronic Healthcare System 2014–2019

“…Kazakhs had higher survival than other ethnic groups. Finally, patients with TB and comorbid conditions such as HIV, DM, stroke and CKD showed lower survival than patients without such comorbidities that were supported by other studies 18–20…”

“…Accumulation of uremic toxins and disturbance of vitamin D metabolism was associated with suppression of the immune system and reactivation of latent TB or development of active TB. Xiao et al reported that the mortality rate for patients with TB and non-dialysis CKD, as well as dialysis CKD, were 37% and 32%, respectively 20. Li et al showed that higher levels of epidermal growth factor receptor were associated with lower risk of TB infection 24…”

“…Xiao et al reported that the mortality rate for patients with TB and non-dialysis CKD, as well as dialysis CKD, were 37% and 32%, respectively. 20 Li et al showed that higher levels of epidermal growth factor receptor were associated with lower risk of TB infection. 24 …”

“…Finally, patients with TB and comorbid conditions such as HIV, DM, stroke and CKD showed lower survival than patients without such comorbidities that were supported by other studies. [18][19][20] TB prevention and treatment in Kazakhstan is monitored and financed by the Ministry of Healthcare and controlled by regional primary healthcare organisations and TB control services. The main prophylaxis measures include administration of Bacille Calmette-Guerin vaccines to infants and children, annual TB skin testing for school-age children, radiography of the chest for the adult population and potential TB contacts tracings.…”

“…Xiao et al reported that the mortality rate for patients with TB and non-dialysis CKD, as well as dialysis CKD, were 37% and 32%, respectively. 20 Li et al showed that higher levels of epidermal growth factor receptor were associated with lower risk of TB infection. 24 Despite the significant contribution of this study to the epidemiological understanding of TB in Kazakhstan, several limitations were identified that need to be discussed.…”