Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Department of Health Services Research, Faculty of Medicine, University of Tsukuba, building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan.
BMC Nephrol. 2020 Oct 1;21(1):420. doi: 10.1186/s12882-020-02065-4.
People with end-stage kidney disease have an increased risk of active tuberculosis (TB). Previous systematic reviews have demonstrated that patients with chronic kidney disease (CKD) have increased risk of severe community-acquired infections. We investigated the association between CKD (prior to renal replacement therapy) and incidence of TB in UK General Practice.
Using the UK Clinical Practice Research Datalink, 242,349 patients with CKD (stages 3-5) (estimated glomerular filtration rate < 60 mL/min/1.73 m for ≥3 months) between April 2004 and March 2014 were identified and individually matched (by age, gender, general practice and calendar time) to a control from the general population without known CKD. The association between CKD (overall and by stage) and incident TB was investigated using a Poisson regression analysis adjusted for age, gender, ethnicity, socio-economic status, chronic obstructive pulmonary disease (COPD) and diabetes.
The incidence of TB was higher amongst patients with CKD compared to those without CKD: 14.63 and 9.89 cases per 100,000 person-years. After adjusting for age, gender, ethnicity, socio-economic status, diabetes and COPD, the association between CKD and TB remained (adjusted rate ratio [RR] 1.42, 95% confidence interval [CI] 1.01-1.85). The association may be stronger amongst those from non-white ethnic minorities (adjusted RR 2.83, 95%CI 1.32-6.03, p-value for interaction with ethnicity = 0.061). Amongst those with CKD stages 3-5, there was no evidence of a trend with CKD severity.
CKD is associated with an increased risk of TB diagnosis in a UK General Practice cohort. This group of patients should be considered for testing and treating for latent TB.
终末期肾病患者患活动性结核病（TB）的风险增加。先前的系统评价已经证明，慢性肾脏病（CKD）患者患严重社区获得性感染的风险增加。我们调查了英国普通实践中 CKD（在进行肾脏替代治疗之前）与结核病发病率之间的关系。
使用英国临床实践研究数据链接，我们在 2004 年 4 月至 2014 年 3 月期间确定了 242349 名 CKD（估计肾小球滤过率<60mL/min/1.73m 持续≥3 个月）患者，并将他们与普通人群中没有已知 CKD 的个体按年龄、性别、普通实践和日历时间进行个体匹配。使用泊松回归分析，调整年龄、性别、种族、社会经济地位、慢性阻塞性肺疾病（COPD）和糖尿病，调查 CKD（整体和各阶段）与结核病之间的关联。
与没有 CKD 的患者相比，CKD 患者的结核病发病率更高：每 100000 人年中有 14.63 和 9.89 例。调整年龄、性别、种族、社会经济地位、糖尿病和 COPD 后，CKD 与结核病之间的关联仍然存在（调整后的比率比 [RR] 1.42，95%置信区间 [CI] 1.01-1.85）。这种关联在非白人少数民族中可能更强（调整后的 RR 2.83，95%CI 1.32-6.03，p 值为种族与 CKD 之间的交互作用 = 0.061）。在 CKD 3-5 期患者中，没有证据表明 CKD 严重程度存在趋势。
CKD 与英国普通实践队列中结核病诊断风险增加有关。这组患者应考虑进行潜伏性结核病的检测和治疗。
