Increased incidence of tuberculosis in patients undergoing hemodialysis

Tuberculosis was diagnosed in 26 patients (6 females and 20 males) undergoing maintenance hemodialysis, with an incidence of 23.6%. Infection was characterized clinically by a very insidious onset, the main symptoms being anorexia, loss of weight and low-grade fever, a very high sedimentation rate and lymphocytes predominant in the peripheral circulation, pleural and peritoneal fluids. Pulmonary tuberculosis was seen in 18 patients (70%), 10 of whom presented with pleural effusions. There were extrapulmonary presentations in 8 of the 26 patients (30%). Most of the patients developed the disease about 1 year from the start of their dialysis treatment. With early therapy all patients survived their tuberculosis disease and no recurrence was seen in up to 5 years of follow-up. Despite earlier reports of high mortality, we suggest that awareness of the increased incidence of tuberculosis in dialysis patients, together with its unusual presentation and consequent early diagnosis, results in a very good prognosis.