Risk factors associated with the development of active tuberculosis among patients with advanced chronic kidney disease

Moran, Ed; Baharani, Jyoti; Dedicoat, Martin; Robinson, Esther; Smith, Gillian; Bhomra, PS; Thien, O. S.; Ryan, Rita M.

doi:10.1016/j.jinf.2018.06.003

Cited by 20 publications

(15 citation statements)

References 17 publications

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“…There are only few studies assessing the rates of active TB after SOT or dialysis in countries with low TB incidence, but our results are similar to findings from a Canadian study of SOT recipients [10], a study from the UK of patients with advanced chronic kidney disease [11], and an Australian study of dialysis patients [12]. It has previously been reported that rates of TB are 20-74 times higher in SOT recipients and patients on dialysis compared to the general population [13][14][15].…”

Section: Discussionsupporting

confidence: 86%

Tuberculosis among Patients Undergoing Solid Organ Transplantation or Dialysis in a Low-Endemic Country, 2004-2017

Helleberg

Cho

Ekenberg

et al. 2020

Tuberculosis Research and Treatment

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Background. The risk of active TB among solid organ transplant (SOT) recipients and patients initiating chronic dialysis in a country with low incidence of TB is not well elucidated. Methods. Patients aged >18 years who were transplanted with a solid organ or initiated chronic dialysis at Copenhagen University Hospital in the period 2004-2017 were followed from date of transplantation or initiation of dialysis. Data on demographics and outcomes were obtained from nationwide registries. Results. We included 1,989 SOT recipients and 1,305 patients initiating chronic dialysis, who were followed for a total of 9,785 and 4,196 person-years (PY), respectively. Only a minority of patients had been screened for latent TB prior to SOT or initiation of dialysis. The incidence rates (IRs)/100,000 PY of TB among patients from medium/high TB endemic areas were 358 (95% CI 115-1,110) and 1,266 (95% CI 681-2354) for SOT and dialysis patients, respectively, whereas IRs among patients of Danish origin were 11 (95% CI 2-81) and 31 (95% CI 4-218). Conclusion. The incidence of TB among immunosuppressed immigrants from medium/high TB endemic countries was very high, while the risk of TB among patients from low-endemic countries was minimal.

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Section: Discussionsupporting

confidence: 86%

Tuberculosis among Patients Undergoing Solid Organ Transplantation or Dialysis in a Low-Endemic Country, 2004-2017

Helleberg

Cho

Ekenberg

et al. 2020

Tuberculosis Research and Treatment

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“…Patients with previously diagnosed DM often had serious comorbidities and DM complications such as chronic kidney disease which itself is an independent risk factor for TB [35], and microvascular and/or macrovascular complications. Patients with newly diagnosed DM had fewer DM complications, but more severe TB, despite better glycaemic control, suggesting that some of those newly diagnosed were experiencing "transient hyperglycaemia" due to severe TB.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study

Ugarte-Gil

Alisjahbana

Ronacher

et al. 2019

Clinical Infectious Diseases

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BackgroundDiabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa.MethodsAge-adjusted DM prevalence was estimated using laboratory glycated hemoglobin (HbA1c) or fasting plasma glucose in TB patients. Detailed and standardized sociodemographic, anthropometric, and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multilevel mixed-effect regression models with robust standard errors.ResultsOf 2185 TB patients (median age 36.6 years, 61.2% male, 3.8% human immunodeficiency virus–infected), 12.5% (267/2128) had DM, one third of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB–DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB–DM patients were older and had a higher body mass index (BMI) (P value < .05). Compared to those with newly diagnosed DM, TB patients with diagnosed DM had higher BMI and HbA1c, less severe TB, and more frequent comorbidities, DM complications, and hypertension (P value < .05).ConclusionsWe show that DM prevalence and clinical characteristics of TB–DM vary across settings. Diabetes is primarily known but untreated, hyperglycemia is often severe, and many patients with TB–DM have significant cardiovascular disease risk and severe TB. This underlines the need to improve strategies for better clinical management of combined TB and DM.

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“…20,21 Moreover, a previous study showed that patients with chronic kidney disease who developed pulmonary TB were significantly more likely to have received intravenous iron therapy, and iron is a co-factor supporting mycobacterial growth. 22 In our study, more than half of the patients had received intravenous iron treatment within the past year, which may also be a risk factor for the development of bone and spine TB.…”

Section: Discussionmentioning

confidence: 78%

Bone and joint tuberculosis in patients undergoing dialysis: clinical features, risk factors, and outcomes in 17 patients

Liu

Wang

et al. 2020

J Int Med Res

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Objective This study was performed to investigate the clinical features, risk factors, and outcomes of bone and joint tuberculosis in patients undergoing dialysis. Methods We systematically reviewed the medical records of 17 patients with bone and joint tuberculosis undergoing dialysis who were admitted to our hospital from January 2009 to January 2019. Results Seventeen patients with bone and joint tuberculosis undergoing dialysis were identified in this retrospective study, and 13 patients were undergoing hemodialysis. The mean age of the 17 patients was 61.3 years (range, 32–82 years), and 10 (58.9%) patients were male. Most of the patients had a low CD4+ cell count and low hemoglobin and albumin levels. Surgery was performed in 6 patients (35.3%), and 13 of the 17 patients (76.4%) were cured. Three patients had bone or spine sequelae, mainly because of a delayed diagnosis, and one patient died of heart failure. Conclusion These findings indicate that older age, a low CD4+ cell count, and low hemoglobin and albumin levels are possible risk factors for bone and spine tuberculosis in patients undergoing dialysis. If diagnosed early, most patients should have a good outcome after anti-tubercular therapy with or without surgery.

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Risk factors associated with the development of active tuberculosis among patients with advanced chronic kidney disease

Cited by 20 publications

References 17 publications

Tuberculosis among Patients Undergoing Solid Organ Transplantation or Dialysis in a Low-Endemic Country, 2004-2017

Tuberculosis among Patients Undergoing Solid Organ Transplantation or Dialysis in a Low-Endemic Country, 2004-2017

Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study

Bone and joint tuberculosis in patients undergoing dialysis: clinical features, risk factors, and outcomes in 17 patients

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