Tuberculosis in dialysis patients

In a retrospective study over a 13-year period, data from one of the largest dialysis units in Canada were reviewed. Seven cases of active tuberculosis were identified among a dialysis population of 433 patients. Although this was not a controlled study the data suggests a greater than 10 fold increase in incidence of tuberculosis among patients with end stage renal disease compared to the total population. The majority of patients were over 40 years of age; race and immigrant status appeared to be risk factors, and tuberculin skin tests in the main were unhelpful diagnostically. Symptoms and signs mimicked that of underlying chronic renal disease in most instances, and extrapulmonary disease occurred in 3 of 7 patients. Therapy proved safe and effective in all cases. In terms of the epidemiological and clinical indices the present study tends to support the observations of investigators in other countries.