The affecting factors and comparison of tuberculin skin test in peritoneal dialysis and hemodialysis patients

The prevalence of latent tuberculosis infection in patients with chronic kidney disease: A systematic review and meta-analysis

Objective

To estimate the prevalence of latent tuberculosis infection (LTBI) in chronic kidney disease (CKD) patients.

Methods

This study was conducted following the PRISMA guidelines. We identified, 3694 studies from the whole search, and 59 studies were included. Each study's quality was assessed using JBI checklist. We employed STATA version 17 for statistical analysis. We assessed heterogeneity using I2 heterogeneity test. Publication bias was assessed using funnel plot and Egger's test. We estimated the pooled LTBI prevalence in CKD patients along with 95%CI.

Results

The pooled prevalence of LTBI among CKD patients using data collected from 53 studies having 12,772 patients was 30.2% (95%CI; 25.5, 34.8). The pooled prevalence among pre-dialysis, hemodialysis, peritoneal dialysis, and renal transplanted patients was 17.8% (95%CI; 3.3, 32.4), 34.8% (95%CI; 29.1, 40.5), 25% (95%CI; 11, 38), and 16% (95%CI; 7, 25), respectively. The pooled prevalence of LTBI stratified by the laboratory screening methods was 25.3% (95%CI: 20.3-30.3) using TST, 28.0% (95%CI; 23.9-32.0) using QFT, and 32.6%, (95%CI: 23.7-41.5) using T-SPOT.

Conclusion

There is high prevalence of LTBI among CKD patients mainly in patients on dialysis. Thus, early diagnosis and treatment of LTBI in CKD patients should be performed to prevent active TB in CKD patients.PROSPERO registration number: CRD42022372441.

Prevalence of Latent Tuberculosis Infection among Patients Undergoing Regular Hemodialysis in Disenfranchised Communities: A Multicenter Study during COVID-19 Pandemic

Background and Objectives: Due to their weakened immune response, hemodialysis (HD) patients with latent tuberculosis infection (LTBI) are at higher risk for active tuberculosis (TB) disease and are more subject to patient-to-patient transmission within dialysis units. Consequently, current guidelines advocate screening these patients for LTBI. To our knowledge, the epidemiology of LTBI in HD patients has never been examined before in Lebanon. In this context, this study aimed to determine LTBI prevalence among patients undergoing regular HD in Northern Lebanon and to identify potential factors associated with this infection. Notably, the study was conducted during the COVID-19 pandemic, which is likely to have catastrophic effects on TB and increase the risk of mortality and hospitalization in HD patients. Materials and Methods: A multicenter cross-sectional study was carried out in three hospital dialysis units in Tripoli, North Lebanon. Blood samples and sociodemographic and clinical data were collected from 93 HD patients. To screen for LTBI, all patient samples underwent the fourth-generation QuantiFERON-TB Gold Plus assay (QFT-Plus). Multivariable logistic regression analysis was used to identify the predictors of LTBI status in HD patients. Results: Overall, 51 men and 42 women were enrolled. The mean age of the study population was 58.3 ± 12.4 years. Nine HD patients had indeterminate QFT-Plus results and were therefore excluded from subsequent statistical analysis. Among the remaining 84 participants with valid results, QFT-Plus was positive in 16 patients, showing a positivity prevalence of 19% (95% interval for p: 11.3%, 29.1%). Multivariable logistic regression analysis showed that LTBI was significantly associated with age [OR = 1.06; 95% CI = 1.01 to 1.13; p = 0.03] and a low-income level [OR = 9.29; 95% CI = 1.62 to 178; p = 0.04]. Conclusion: LTBI was found to be prevalent in one in five HD patients examined in our study. Therefore, effective TB control measures need to be implemented in this vulnerable population, with special attention to elderly patients with low socioeconomic status.

Comparison of the Prevalence of Latent Tuberculosis Infection among Non-Dialysis Patients with Severe Chronic Kidney Disease, Patients Receiving Dialysis, and the Dialysis-Unit Staff: A Cross-Sectional Study

Background

Patients with renal failure are vulnerable to tuberculosis, a common worldwide infectious disease. In the growing dialysis population, the risk for tuberculosis among the associated sub-groups is important but unclear. This study investigated latent tuberculosis infection (LTBI) in patients with severe chronic kidney disease (CKD) and among dialysis-unit staff caring for patients on dialysis.

Methods

From January 2012 to June 2013, patients undergoing dialysis, those with severe CKD (estimated glomerular filtration rate <30ml/min/1.73 m²), and the dialysis-unit staff (nursing staff and doctors in hemodialysis units) in several Taiwan hospitals were prospectively enrolled. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine LTBI. Predictors for LTBI were analyzed.

Results

Of the 599 participants enrolled, 106 (25%) in the dialysis group were IGRA positive. This was higher than the seven (11%) among severe CKD patients and 12 (11%) in the dialysis-unit staff. Independent predictors of LTBI in patient with renal dysfunction were old age (odds ratio [OR]: 1.03 [1.01–1.04] per year increment), prior TB lesion on chest radiograph (OR: 2.90 [1.45–5.83]), serum albumin (OR: 2.59 [1.63–4.11] per 1 g/dl increment), and need for dialysis (OR: 2.47, [1.02–5.95]). The QFT-GIT response was similar among the three groups. Malignancy (OR: 4.91 [1.84–13.10]) and low serum albumin level (OR: 0.22 [0.10–0.51], per 1 g/dl decrease) were associated with indeterminate IGRA results.

Conclusions

More patients on dialysis have LTBI compared to those with severe CKD and the dialysis-unit staff. Old age, prior radiographic TB lesion, high serum albumin, and need for dialysis are predictors of LTBI in patients with renal failure. Patients with severe CKD are a lower priority for LTBI screening. The hemodialysis environment is not a risk for LTBI and dialysis-unit staff may be treated as general healthcare workers.

Tuberculin skin test and boosted reactions among newly employed healthcare workers: an observational study

Objective

To evaluate the prevalence of and factors associated with latent tuberculosis infection (LTBI) based on the tuberculin skin test (TST) and to estimate the boosted reaction rate among newly employed healthcare workers (HCWs).

Design

Newly employed HCWs between January 2010 and July 2012 at Severance Hospital in South Korea were enrolled in this study. A one-step TST was conducted before October 2011, and a two-step TST after October 2011.

Results

Of 2132 participants, 778 (36.5%) had positive TST results. Being older (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.06–1.13, P<0.001), male (OR 1.78, 95% CI 1.21–2.62, P = 0.003), rejoining the hospital workforce (OR 1.58, 95% CI 1.04–2.40, P = 0.032), and having a previous history of tuberculosis (TB) (OR 18.21, 95% CI 2.15–154.10, P = 0.008) during the one-step period, and being older (OR 1.15, 95% CI 1.10–1.21, P<0.001) during the two-step period were significantly associated with a positive TST. A two-step TST was performed in 556 HCWs, and a boosted reaction was observed in 79 (14.2%). The induration size on the first TST (5–9-mm group) was the only factor associated with a boosted reaction on the second TST.

Conclusions

The prevalence of LTBI based on the TST among newly employed HCWs was high. The boosted reaction rate on two-step TST was not low; therefore, the use of two-step TST may be necessary for regular monitoring in countries with an intermediate TB burden and a high rate of Bacillus Calmette-Guérin vaccination.