Metry Abdul Massiah, Al Salmi Issa, Al-Abri Seif, Al Ismaili Faisal, Al Mahrouqi Yaqoub, Hola Alan, Shaheen Faissal A M
Department of Renal Medicine, The Royal Hospital, Muscat, Oman.
Department of Infectious Disease, The Royal Hospital, Muscat, Oman.
Saudi J Kidney Dis Transpl. 2017 Jul-Aug;28(4):806-817.
The United States Renal Data System showed 1.2% and 1.6% incidences of tuberculosis (TB) in patients on peritoneal dialysis and hemodialysis (HD), respectively. Kidney transplant (KTX) patients have higher rates. We studied the epidemiology and outcome of TB in patients with kidney dysfunction in a tertiary care hospital in the past decade. We examined data of patients with TB with and without kidney dysfunction from 2006 to 2015 through an electronic system. Statistical analysis was completed using Stata software, Chicago, IL, USA. We found 581 patients with active TB of whom 37 had renal dysfunction including chronic kidney disease, HD, and KTX. No difference was found in the prevalence, age, or gender predilection. The age ranged from 1 to 95 with a mean (standard deviation) of 38.6 (21.1) years. The incidence of TB is 3 per 100,000. The number of patients per year with active TB ranges from 52 to 128 and 3 to 4 in the general population and kidney dysfunction group, respectively. Sixty-five percent of patients with kidney dysfunction had pulmonary TB, 5% had pleurisy, and 30% had extrapulmonary TB. Eighty-four percent of patients with kidney dysfunction completed the course of treatment with 16% treatment failure and 0.4% developed multidrug-resistant TB; 8% were lost to follow-up and 8% died during the treatment period. This study showed no gender predilection for TB in the general population and immunocompromised. Duration of symptoms before diagnosis of TB was shorter in kidney dysfunction patients in comparison to the general population. TB cultures were the most positive tests whereas bronchoalveolar lavage and skin test were the least positive for detecting TB in the kidney dysfunction group. Improvement in registries and screening is required to enhance the capturing rate and detection among this group, as well as providing accurate data to health authorities and the public about the magnitude, future trends, treatments, and outcomes regarding TB in kidney dysfunction.
美国肾脏数据系统显示，接受腹膜透析和血液透析（HD）的患者中结核病（TB）的发病率分别为1.2%和1.6%。肾移植（KTX）患者的发病率更高。我们研究了过去十年中一家三级护理医院肾功能不全患者结核病的流行病学和转归。我们通过电子系统检查了2006年至2015年有和没有肾功能不全的结核病患者的数据。使用美国伊利诺伊州芝加哥的Stata软件完成统计分析。我们发现581例活动性结核病患者，其中37例有肾功能不全，包括慢性肾脏病、血液透析和肾移植。在患病率、年龄或性别偏好方面未发现差异。年龄范围为1至95岁，平均（标准差）为38.6（21.1）岁。结核病发病率为每10万人3例。每年活动性结核病患者数量在普通人群和肾功能不全组中分别为52至128例和3至4例。65%的肾功能不全患者患有肺结核，5%患有胸膜炎，30%患有肺外结核。84%的肾功能不全患者完成了治疗疗程，16%治疗失败，0.4%发展为耐多药结核病；8%失访，8%在治疗期间死亡。这项研究表明，普通人群和免疫功能低下者中结核病无性别偏好。与普通人群相比，肾功能不全患者在结核病诊断前的症状持续时间较短。在肾功能不全组中，结核培养是最阳性的检测方法，而支气管肺泡灌洗和皮肤试验检测结核病的阳性率最低。需要改进登记和筛查，以提高该组的捕获率和检测率，并向卫生当局和公众提供有关肾功能不全患者结核病的规模、未来趋势、治疗和转归的准确数据。
