Evaluation of subclinical tuberculosis among end-stage kidney disease patients on hemodialysis

Patients with chronic kidney disease and end-stage kidney disease (ESKD) are at increased risk of developing tuberculosis (TB). This study was to assess the proportion of positive interferon-gamma release assays (IGRAs) and its associated factors in latent and subclinical TB.

An observational study was conducted among asymptomatic adult patients with ESKD and hemodialysis. Positive PPD test or a previously documented positive PPD Active pulmonary or extrapulmonary tuberculosis patients were excluded. The clinical, laboratory, chest radiograph, and blood IGRAs assay were done at baseline and 6 months with additional sputum Xpert MTB/RIF, and cultures among the positive IGRAs.

About 159 participants were enrolled with the median age of 69 (IQR, 58-80). There were 82 male participants (51.6%). The most common comorbidities were hypertension, diabetes mellitus, and dyslipidemia. Of 159 participants, 28 (17.6%) had a positive IGRA test at baseline. Among the 26 surviving IGRA-positive participants at month 6, chest radiography revealed abnormalities in 22 (84.6%), with five (22.7%) showing findings specified as tuberculosis-related. Five participants (19.2%) developed symptoms related to tuberculosis during follow-up. Diabetes mellitus (odds ratio [OR] 2.54, 95% CI 1.04-6.18; P = 0.00) and hypocalcemia (OR 3.93, 95% CI 1.56-9.90; P = 0.004). were independently associated with IGRA positivity. Twelve participants died unrelated to TB. Baseline EQ-5D-5L utility scores and a visual analog scale score below 60 and hypoalbuminemia were the strongest predictors of mortality.

IGRA is an important tool for screening test for TB in in ESKD patients with hemodialysis. High IGRA positivity with high confirmed TB at 6 months follow up was detected. Diabetes mellitus and hypocalcemia were independently associated with IGRA positivity.