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. 2013 Jul 25;8(7):e69556.
doi: 10.1371/journal.pone.0069556. Print 2013.

Increased risk of active tuberculosis following acute kidney injury: a nationwide, population-based study

Vin-Cent Wu  1 , Chen-Yi Wang, Chih-Chung Shiao, Chia-Hsui Chang, Hui-Yu Huang, Tao-Min Huang, Chun-Fu Lai, Meng-Chun Lin, Wen-Je Ko, Kwan-Dun Wu, Chong-Jen Yu, Chin-Chung Shu, Chih-Hsin Lee, Jann-Yuan Wang; National Taiwan University Study Group on Acute Renal Failure; Taiwan Anti-Mycobacteria Investigation Group
Collaborators, Affiliations

Increased risk of active tuberculosis following acute kidney injury: a nationwide, population-based study

Vin-Cent Wu et al. PLoS One. .

Abstract

Background: Profound alterations in immune responses associated with uremia and exacerbated by dialysis increase the risk of active tuberculosis (TB). Evidence of the long-term risk and outcome of active TB after acute kidney injury (AKI) is limited.

Methods: This population-based-cohort study used claim records retrieved from the Taiwan National Health Insurance database. We retrieved records of all hospitalized patients, more than 18 years, who underwent dialysis for acute kidney injury (AKI) during 1999-2008 and validated using the NSARF data. Time-dependent Cox proportional hazards model to adjust for the ongoing effect of end-stage renal disease (ESRD) was conducted to predict long-term de novo active TB after discharge from index hospitalization.

Results: Out of 2,909 AKI dialysis patients surviving 90 days after index discharge, 686 did not require dialysis after hospital discharge. The control group included 11,636 hospital patients without AKI, dialysis, or history of TB. The relative risk of active TB in AKI dialysis patients, relative to the general population, after a mean follow-up period of 3.6 years was 7.71. Patients who did (hazard ratio [HR], 3.84; p<0.001) and did not (HR, 6.39; p<0.001) recover from AKI requiring dialysis had significantly higher incidence of TB than patients without AKI. The external validated data also showed nonrecovery subgroup (HR = 4.37; p = 0.049) had high risk of developing active TB compared with non-AKI. Additionally, active TB was associated with long-term all-cause mortality after AKI requiring dialysis (HR, 1.34; p = 0.032).

Conclusions: AKI requiring dialysis seems to independently increase the long-term risk of active TB, even among those who weaned from dialysis at discharge. These results raise concerns that the increasing global burden of AKI will in turn increase the incidence of active TB.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow diagram of the study sample.
(Abbreviations; AKI, acute kidney injury; CKD, chronic kidney disease; TB, tuberculosis; ESRD, end-stage renal disease; ICU, intensive care unit).
Figure 2
Figure 2. Cox proportional hazards model for long-term active TB events among the non-AKI group, recovery AKI subgroup, and nonrecovery AKI sub-group (AKI, acute kidney injury).
Figure 3
Figure 3. The hazard ratios (HRs) and 95% CIs for long-term tuberculosis, adjusted for the AKI–dialysis and non-AKI groups.
*adjusted for age and sex. Abbreviations; COPD, chronic obstructive pulmonary disease; ICU.
See this image and copyright information in PMC

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