Tuberculosis screening practices and outcomes in an australian dialysis unit

Area of Science:

• Nephrology
• Infectious Disease Epidemiology

Background:

• The World Health Organisation (WHO) recommends routine latent tuberculosis infection (LTBI) screening for all dialysis patients in high-income countries.
• Australian dialysis units often employ a targeted screening approach, deviating from WHO guidelines.
• This study evaluates the validity of a targeted screening strategy in an Australian dialysis setting.

Purpose of the Study:

• To assess the effectiveness and outcomes of a targeted screening approach for LTBI in an Australian dialysis unit.
• To compare the incidence of active tuberculosis in screened versus unscreened dialysis patients.
• To inform future screening guidelines for dialysis patients in Australia.

Main Methods:

• Retrospective review of 472 new dialysis patients from 2012-2018.
• Analysis of patient demographics, comorbidities, LTBI screening using Quantiferon Gold (QFG), and active tuberculosis (TB) development.
• Comparison of outcomes between patients screened for LTBI and those not screened.

Main Results:

• Of 472 patients, 229 (48.5%) were screened with QFG, primarily for transplantation waitlisting.
• 34 patients (14.8%) had a positive QFG result; 22% of patients were from WHO high-risk countries.
• Two cases of active TB occurred in the screened cohort; none in the unscreened cohort. Origin from a WHO high-risk country was associated with positive QFG (OR 10.4).

Conclusions:

• The current targeted screening approach did not demonstrate a clear benefit in preventing active TB within this dialysis unit.
• A larger sample size is required to definitively assess the impact of the screening strategy.
• Further analysis across Australian dialysis services is warranted to evaluate risks and benefits of wider screening.