Current tuberculosis status and challenges among dialysis patients in Japan: A nationwide cross-sectional survey

Since 2021, Japan has been classified as a country with a low prevalence of tuberculosis (TB). Although dialysis patients have significantly higher incidences of TB and mortality, no recent nationwide surveys have assessed the TB status among dialysis patients in Japan. We conducted a nationwide cross-sectional survey of all 4167 dialysis facilities registered with the Japanese Society for Dialysis Therapy and collected facility-level data between April 2022 and March 2024. The survey assessed TB diagnoses (latent tuberculosis infection [LTBI] and active TB), diagnostic triggers, screening practices and treatment rates for LTBI, epidemiological data and clinical characteristics of active TB, incidence of TB close contacts, healthcare providers' perceptions of TB in dialysis patients, and challenges associated with managing TB in dialysis patients. Survey responses were received from 2468 facilities with 194,720 dialysis patients. Among these patients, 331 were diagnosed with LTBI and 196 developed active TB during the 2-year study period. The LTBI rate was 85.0 cases per 100,000 person-years (95% confidence interval: 75.8-94.2), and the estimated annual rate of active TB was 50.3 cases per 100,000 person-years (95% confidence interval: 43.3-57.5). LTBI was most frequently diagnosed during screening before dialysis initiation (42.7%); however, only 4.5% of facilities conducted routine interferon-gamma release assay screening. The LTBI treatment rate was 75.2%. Among patients with active TB, diabetic nephropathy was the most prevalent underlying disease (44.2%); additionally, extrapulmonary TB was frequently observed. The incidence of active TB was highest among patients approximately 70 years of age (40.2%). Furthermore, 22.2% of patients developed TB within 3 months after dialysis initiation and 61.6% developed TB more than 1 year later. The mortality rate of these patients was 28.8%. Concerningly, 43.2% of dialysis healthcare staff appeared unaware of the TB risk, and 63.8% of facilities reported challenges regarding patient transfer and care coordination. TB is a significant burden among dialysis patients in Japan. Therefore, early awareness and treatment of TB, standardized LTBI screening protocols, robust treatment infrastructure with enhanced awareness among healthcare providers, as well as strengthened collaboration between medical institutions, government agencies, and TB-specialized healthcare facilities are necessary.