The outcome of tuberculosis in patients on chronic hemodialysis

In patients on regular hemodialysis, the incidence of tuberculosis is high.

We present 18 (6.08%) tuberculosis patients among 296 patients on regular hemodialysis between 1980 and 1996.

Pulmonary tuberculosis was seen in 11 (61%) patients, 7 (38%) of whom presented with pleural effusion. Tuberculosis was extrapulmonary in 7 (38%) patients. There were 4 (22.2%) patients with tuberculous lymphadenitis, 2 (11.1%) with tuberculous peritonitis, 1 (5.5%) with urinary tuberculosis. Intermittent fever, malasia and dyspnea were the most common symptoms. The mean duration on hemodialysis before diagnosis of tuberculosis were 22.22+/-7.19 months and the mean duration of symptoms prior to treatment were 34.16+/-3.36 days. Tuberculosis was diagnosed in 10 (55.5%) patients within the first 4 months of dialysis and in 8 (44.4%) between the 1st and the 8th year of hemodialysis treatment. Our patients were treated with isoniazid, rifampicin, morfazinamid and ethambutol. Four patients died within the first 4 months of the antituberculosis therapy, in all of whom tuberculosis was diagnosed within the 4 months of dialysis. In patients who died, duration of symptoms ranged from 30 days to 60 days, mean 42 days. Overall mortality was 22.2% and correlated with the duration of symptoms prior to initiation of antituberculosis and hemodialysis therapy. Fourteen patients (77.7%) who survived longer than one year were clinically cured.

Our results suggest that the mortality of tuberculosis is high in patients in the early phase of maintenance dialysis and delay in the disease treatment of tuberculosis. Because of their generally poor state of nutrition, and depressed cellular immunity, the mortality is high in patients in the early stage of maintenance hemodialysis. Therefore, if the diagnosis is delayed, mortality is higher. Tuberculosis should be considered strongly and treated promptly if suspected.