The association between chronic kidney disease and tuberculosis; a comparative cohort study in England

Abstract

Background People with end-stage kidney disease have an increased risk of active tuberculosis (TB). Previous systematic reviews have demonstrated that patients with chronic kidney disease (CKD) have increased risk of severe community-acquired infections. We investigated the association between CKD (prior to renal replacement therapy) and incidence of TB in UK General Practice. Methods Using the UK Clinical Practice Research Datalink, 242,349 patients with CKD (stages 3-5) (estimated glomerular filtration rate < 60 mL/min/1.73 m2 for ≥3 months) between April 2004 and March 2014 were identified and individually matched (by age, gender, general practice and calendar time) to a control from the general population without known CKD. The association between CKD (overall and by stage) and incident TB was investigated using a Poisson regression analysis adjusted for age, gender, ethnicity, socio-economic status, chronic obstructive pulmonary disease (COPD) and diabetes. Results The incidence of TB was higher amongst patients with CKD compared to those without CKD: 14.63 and 9.89 cases per 100,000 person-years. After adjusting for age, gender, ethnicity, socio-economic status, diabetes and COPD, the association between CKD and TB remained (adjusted rate ratio [RR] 1.42, 95% confidence interval [CI] 1.01–1.85). The association may be stronger amongst those from non-white ethnic minorities (adjusted RR 2.83, 95%CI 1.32–6.03, p-value for interaction with ethnicity = 0.061). Amongst those with CKD stages 3–5, there was no evidence of a trend with CKD severity. Conclusions CKD is associated with an increased risk of TB diagnosis in a UK General Practice cohort. This group of patients should be considered for testing and treating for latent TB.

Risk factors of latent tuberculosis among chronic kidney disease with routine haemodialysis patients

“…Tuberculosis (TB) risk among chronic kidney disease (CKD) patients is greater than normal kidney function subjects [1] . Coexistence of systemic inflammation and immunocompromised are the common implication of uremic state.…”

“…Coexistence of systemic inflammation and immunocompromised are the common implication of uremic state. These two mechanisms contribute to the morbidity and mortality of CKD patients [1] , [2] . Uremic state disrupts the immune response through several pathways including decreased phagocytosis activity of granulocytes and monocytes/macrophages, impaired antigen presentation capacity of antigen presenting cells (APC), decreased in amount of presented antigen on dendritic cells surface, decreased capacity of B cells production, increased T cell apoptosis, and disrupted cell-mediated immunity (CMI) [2] .…”

Drug-Resistant Pulmonary Tuberculosis

“…Furthermore, end-stage CKD patients are also more likely to acquire TB infection through the disruption of normal immune responses (Ruzangi et al, 2020). This condition leads to defective phagocytic activity, impaired antigen presentation capability, decreased B-cell and antibodies production, increased apoptotic rates, and compromised cell-mediated immunity (Cohen & Hörl, 2012).…”

Secondary Immunodeficiency Related to Kidney Disease (SIDKD)—Definition, Unmet Need, and Mechanisms

“…20,24,25 In .230,000 Canadian patients, the risk for hospitalization due to community-acquired pneumonia increased with decreasing eGFR. 26 The influenza A virus subtype H1N1 (swine influenza), 27 severe acute respiratory syndrome, 28,29 and tuberculosis 30,31 are associated with a longer duration in the hospital and a more aggressive clinical course or death in patients receiving dialysis, compared with the general population (Table 2). Similar observations have been documented for parasitic infections, e.g., Plasmodium falciparum or Plasmodium vivax 32 and protozoa 33 in patients with CKD in developing countries.…”