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. 2013 Mar-Apr;39(2):214-20.
doi: 10.1590/s1806-37132013000200013.

Prevalence of latent tuberculosis infection and risk of infection in patients with chronic kidney disease undergoing hemodialysis in a referral center in Brazil

[Article in English, Portuguese]
Jane Corrêa Fonseca  1 , Waleska Teixeira Caiaffa, Mery Natali Silva Abreu, Katia de Paula Farah, Wânia da Silva Carvalho, Silvana Spindola de Miranda
Affiliations

Prevalence of latent tuberculosis infection and risk of infection in patients with chronic kidney disease undergoing hemodialysis in a referral center in Brazil

[Article in English, Portuguese]
Jane Corrêa Fonseca et al. J Bras Pneumol. 2013 Mar-Apr.

Abstract
in English, Portuguese

Objective: To determine the prevalence of latent tuberculosis infection (LTBI) and the risk of infection in patients with chronic kidney disease treated at a hemodialysis center.

Methods: We included 307 patients with chronic kidney disease undergoing hemodialysis at the Mineiro Institute of Nephrology, located in the city of Belo Horizonte, Brazil. All of the patients were submitted to tuberculin skin tests (TSTs). We investigated the booster effect and TST conversion. If the initial TST (TST1) was negative, a second TST (TST2) was performed 1-3 weeks later in order to investigate the booster effect. If TST2 was also negative, a third TST (TST3) was performed one year after TST2 in order to determine whether there was TST conversion.

Results: When we adopted a cut-off induration of 5 mm, the prevalence of LTBI was 22.2% on TST1, increasing by 11.2% on TST2. When we adopted a cut-off induration of 10 mm, the prevalence of LTBI was 28.5% on TST1, increasing by 9.4% on TST2. The prevalence of LTBI increased significantly from TST1 to TST2 (booster effect), as well as from TST2 to TST3 (p < 0.01 for both). In our sample, the mean annual risk of infection was 1.19%.

Conclusions: In the population studied, the prevalence of LTBI was high, and the mean annual risk of infection was similar to that reported for the general population of Brazil, which suggests recent infection.

OBJETIVO:: Determinar a prevalência da infecção latente por Mycobacterium tuberculosis (ILMT) e o risco de infecção em pacientes com insuficiência renal crônica em um centro de hemodiálise.

MÉTODOS:: Foram incluídos no estudo 307 pacientes com insuficiência renal crônica em tratamento hemodialítico no Instituto Mineiro de Nefrologia, na cidade de Belo Horizonte (MG). Todos os pacientes foram submetidos a testes tuberculínicos (TTs). O efeito booster e a viragem tuberculínica foram avaliados. Se o primeiro TT (TT1) era negativo, um segundo (TT2) era realizado 1-3 semanas após o TT1 para investigar o efeito booster. Se o TT2 também era negativo, um terceiro (TT3) era realizado um ano após o TT2 para identificar a viragem tuberculínica.

RESULTADOS:: A prevalência da ILMT, quando considerado o ponto de corte de 5 mm de enduração, foi de 22,2% no TT1, com incremento de 11,2% no TT2. A prevalência da ILMT, quando considerado o ponto de corte de enduração de 10 mm, foi de 28,5% no TT1, com incremento de 9,4% no TT2. Um aumento significativo da prevalência da ILMT foi observado entre TT1 e TT2 (efeito booster) e entre TT2 e TT3 (p < 0,01 para ambos). Na nossa amostra, o risco médio anual de infecção foi de 1,19%.

CONCLUSÕES:: Na população estudada, a prevalência da ILMT foi alta, e o risco de infecção foi semelhante ao da população geral no Brasil, o que sugere infecção recente.

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