Active tuberculous infection among adult Sudanese patients on long term peritoneal dialysis

The prevalence of tuberculosis in Sudan is 209 cases per 100,000 populations. There are no reports available regarding the prevalence of tuberculosis among the end-stage kidney disease and dialysis populations.

We reviewed the medical records of all adults who were on peritoneal dialysis (PD) in the Sudan Peritoneal Dialysis Program, during the period from June 2005 to December 2011. Those diagnosed as having active tuberculous infections were retrospectively studied regarding their demography, clinical presentation and outcomes.

Out of 350 patients in our program, 19 were diagnosed as having active tuberculosis (5.4%). All patients were diagnosed during their first year on peritoneal dialysis, 74% were males; the mean age was 37 ± 11 years, extrapulmonary tuberculosis was seen in 16/19 (84%) patients and it was abdominal in nine of the 16 (47%) patients. In addition to high clinical suspicion, the diagnosis of active tuberculosis was supported by tissue biopsy findings in 16%, positive polymerase chain reaction in 26%, exudative ascites with suggestive radiological features in 21%, strongly positive tuberculin test in 21% and a favourable response to empirical antituberculous therapy in 26% of patients. HIV test was negative in all 19 patients and only one patient tested positive for hepatitis B viral infection. Antituberculous drugs side effects were seen in 68% of patients. Forty seven percent of patients showed complete recovery and continued on peritoneal dialysis. Our case fatality was 32%.

Abdominal tuberculosis is common among PD patients and its diagnosis should always be considered in suspected patients.