Risk factors of latent tuberculosis among chronic kidney disease with routine haemodialysis patients

Abstract

Introduction: Since immune system alteration occurs, chronic kidney disease (CKD) on routine haemodialysis (HD) patients have a greater risk for latent tuberculosis (LTB). LTB needs special attention so that it does not develop into an active form, because infection in CKD patients increases the mortality. This study aims to determine the risk factors that associated with LTB among CKD on routine HD patients.

Methods: This was a cross-sectional study conducted in Haemodialysis Unit, Hasan Sadikin General Hospital, Bandung. The subjects were recruited from March-May 2020. Subjects aged > 18 years at least have undergoing HD in 3 months and twice a week HD were included in this study. Patients with active tuberculosis (TB) suspected, malignancy, or immunocompromised were excluded. LTB was diagnosed using interferon-γ release assays (IGRA). All data including age, sex, CKD etiologies, smoking status, HD adequacy that assessed using KT/V and urea reduction ratio (URR), and contact status with TB patients were obtained and recorded in case report form.

Results: A total of 120 subjects were involved. LTB based on IGRA was occurred in 39.2% subjects, while 56.7% and 4.1% subjects had negative and indeterminate IGRA, respectively. Adequacy of HD based on KT/V value was not significantly different between positive and negative IGRA subjects. Positive IGRA subjects had lower URR (p = 0.042). Smoking status had significant association with LTB (OR = 2.5[95%CI 1.2-5.4, p = 0.017). Furthermore, URR < 73% also had significant association with LTB (OR = 2.6[1.2-5.6, p = 0.013).

Conclusion: Smoking status and HD adequacy based on URR < 73% are associated factors that contribute to LTB among CKD on HD patients.

Keywords: Chronic kidney disease; Haemodialysis; Latent tuberculosis; Risk factors.

Fig. 1

Flowchart of Subjects Recruitment. ATD: antituberculosis drugs; CKD: chronic kidney disease; HD: haemodialysis; HIV: human immunodeficiency virus; IGRA: interferon-γ release assay; TB: tuberculosis.