Romanowski Kamila, Rose Caren, Cook Victoria J, Sekirov Inna, Morshed Muhammad, Djurdjev Ognjenka, Levin Adeera, Johnston James C
British Columbia Centre for Disease Control, Vancouver, Canada.
The University of British Columbia, Vancouver, Canada.
Can J Kidney Health Dis. 2020 Jul 2;7:2054358120937104. doi: 10.1177/2054358120937104. eCollection 2020.
People undergoing chronic dialysis are at an increased risk of active tuberculosis (TB). In 2012, the Canadian province of British Columbia began systematically screening people initiating dialysis for latent TB using interferon-gamma release assay (IGRA), and treating when appropriate.
The objective of this study was to compare active TB rate in people who initiated dialysis and were screened using an IGRA compared with those not screened during the same period.
Retrospective cohort study.
British Columbia (BC), a Canadian province of 5.0 million people with an active TB incidence of 5.1 per 100 000 population.
All people in BC who initiated at least 90 days of dialysis between January 2012 and May 2017 were included in the study. People were excluded if they were <18 years of age or had a prior history of active TB diagnosis or treatment for latent TB.
A retrospective cohort was created of British Columbians who initiated dialysis between 2012 and 2017. Individuals were stratified into a screened and nonscreened group. Multivariable Cox regression was used to determine the association between latent TB screening and the development of active TB. The primary outcome was incident active TB, either microbiologically confirmed or clinically diagnosed.
Of the 3190 people included in the study, 1790 (56.1%) were screened, of which 152 (8.5%) initiated latent TB treatment postscreening. During follow-up, incident active TB was diagnosed in 6 (0.3%) of the 1790 people screened, compared with 11 (0.8%) of the 1400 people who received no screening. In multivariable analysis, latent TB screening and treatment was associated with a significant reduction in the rate of active TB (adjusted hazard ratio = 0.3, 95% confidence interval = 0.1-0.8; < .01).
This was an observational retrospective study and the potential for unmeasured confounding should be carefully assessed.
These findings suggest that systematically screening and treating people initiating dialysis can significantly decrease the rate of active TB in this high-risk population. Given the importance of screening high-risk groups, the results from this analysis could inform scale-up of TB screening in dialysis programs in other low incidence regions. Trial registration is not applicable as this was a retrospective cohort analysis and not a randomized trial.
接受长期透析的人群患活动性肺结核（TB）的风险增加。2012年，加拿大不列颠哥伦比亚省开始系统地使用干扰素-γ释放试验（IGRA）对开始透析的人群进行潜伏性结核筛查，并在适当的时候进行治疗。
本研究的目的是比较开始透析并使用IGRA进行筛查的人群与同期未接受筛查的人群的活动性结核发病率。
回顾性队列研究。
不列颠哥伦比亚省（BC），加拿大一个拥有500万人口的省份，活动性结核发病率为每10万人中有5.1例。
纳入2012年1月至2017年5月期间在BC省开始至少90天透析的所有人。年龄小于18岁或有活动性结核诊断史或曾接受潜伏性结核治疗的人被排除在外。
建立一个2012年至2017年期间开始透析的BC省居民的回顾性队列。个体被分为筛查组和未筛查组。使用多变量Cox回归来确定潜伏性结核筛查与活动性结核发生之间的关联。主要结局是新发活动性结核，通过微生物学确诊或临床诊断。
在纳入研究的3190人中，1790人（56.1%）接受了筛查，其中152人（8.5%）在筛查后开始接受潜伏性结核治疗。在随访期间，1790名接受筛查的人中，有6人（0.3%）被诊断为新发活动性结核，而1400名未接受筛查的人中，有11人（0.8%）被诊断为新发活动性结核。在多变量分析中，潜伏性结核筛查和治疗与活动性结核发病率的显著降低相关（调整后的风险比=0.3，95%置信区间=0.1-0.8；P<.01）。
这是一项观察性回顾性研究，应仔细评估未测量混杂因素的可能性。
这些发现表明，对开始透析的人群进行系统筛查和治疗可显著降低这一高危人群的活动性结核发病率。鉴于筛查高危人群的重要性，该分析结果可为其他低发病率地区扩大透析项目中的结核筛查提供参考。由于这是一项回顾性队列分析而非随机试验，因此不适用试验注册。
