Incidence of tuberculosis in nondialysis-requiring CKD patients

ABSTRACT

Background: Tuberculosis is a common infection of chronic kidney disease patients in developing countries.Methods: A retrospective study of 2960 non-dialysis requiring chronic kidney disease patients was made to determine the incidence and understand the demographic features of patients that lead to the development of tuberculosis on the basis of cell count, routine, ADA estimation, ZN stain, culture and PCR.Results: Between Jan 2000 and March 2017, the incidence of tuberculosis in no dialysis-requiring chronic kidney disease group was 10.3% in which pulmonary tuberculosis was 3.9% while extrapulmonary tuberculosis was 6.4%. Among extrapulmonary tuberculosis, 52% positivity was seen in pleural effusion, 16.40% in ascetic fluid, 10.10% in lymphnodes, 7.4% in urinary tract, and 3.7% in CSF, 2.6% in pericardial fluid, 1.6% in adrenal tissue and 1.1% in spine. ZN stain was positive in 48.6%, culture isolated mycobacterium 98.3%, PCR 93.4%, the mean ADA levels was 22.90+11.24 IU/ml and 60.49+07.24 IU/ml in CSF and body fluids respectively. Outcome analysis revealed 15.4% mortality rate in diagnosed tuberculosis cases while maximum loss of life was seen in diabetic patients.Conclusions:In the present study we observed 10.3% incidence of tuberculosis among nondialysis-requiring chronic kidney disease patients. Extrapulmonary form of tuberculosis predominates over pulmonary form. Unusual presentation and lococalization of symptoms should not be overlooked. Prompt and early diagnosis of tuberculosis is especially required in endemic areas.