Tuberculosis in patients on hemodialysis

Area of Science:

• Nephrology
• Infectious Diseases
• Epidemiology

Background:

• End-stage renal disease (ESRD) patients undergoing hemodialysis are immunocompromised.
• Tuberculosis (TB) is a significant global health concern, particularly in vulnerable populations.
• Previous studies suggest a potential link between renal disease and TB reactivation.

Purpose of the Study:

• To investigate the incidence and risk factors of active tuberculosis (TB) in patients with end-stage renal disease (ESRD) undergoing hemodialysis.
• To identify specific ethnic groups at higher risk for TB within the dialysis population.
• To explore the potential pathogenetic pathways of TB development in ESRD patients.

Main Methods:

• Retrospective analysis of 102 patients with ESRD undergoing hemodialysis between 1972 and 1980.
• Case identification of patients who developed active tuberculosis (TB) during the study period.
• Analysis of patient demographics, medical history, clinical presentation, and treatment outcomes.

Main Results:

• Six out of 102 (5.9%) hemodialysis patients developed active tuberculosis (TB).
• Three of these six patients were Yemenite Jews, representing a disproportionately high incidence within this ethnic group.
• Fever of unknown origin was the most common presenting symptom, and four patients had a history of previous pulmonary TB.

Conclusions:

• Hemodialysis patients, particularly those of Yemenite Jewish ethnicity, are at increased risk for active tuberculosis (TB).
• Reactivation of dormant TB appears to be the primary mechanism for disease development in this cohort.
• Prompt diagnosis and triple therapy (isoniazid, rifampicin, ethambutol) can lead to recovery, though mortality remains a concern.