Li Chia-Hsiang, Chen Hung-Jen, Chen Wei-Chun, Tu Chih-Yen, Hsia Te-Chun, Hsu Wu-Huei, Chang Chiz-Tzung, Huang Chiu-Ching, Bau Da-Tian, Chou Che-Yi
Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
School of Medicine, China Medical University, Taichung, Taiwan.
Front Med (Lausanne). 2021 Aug 13;8:715010. doi: 10.3389/fmed.2021.715010. eCollection 2021.
Patients with chronic kidney disease (CKD) receiving maintenance renal replacement therapy are at higher risk of tuberculosis (TB) infection. The risk of TB infection in CKD patients not receiving dialysis is unknown. We conduct this study to test the hypothesis that TB infection is negatively correlated to renal function. Non-dialysis CKD stage 1-5 patients, admitted in China Medical University Hospital from January of 2003 to May of 2014, were enrolled in this study and were prospectively followed up to the diagnosis of TB, death, loss to follow-up, or December 2014. The risk factors of TB infection were analyzed using competing-risks regression analysis with time-varying covariates. The initiation of dialysis and patients' death were considered as competing events. Patients' estimated glomerular filtration rate (eGFR) and body mass index (BMI) were recorded at enrollment. They were followed-up for a median duration of 1.4 years. Of the 7221 patients, TB infection was identified in 114 patients. Higher eGFR was associated with lower risk of TB infection ( < 0.01). The adjusted subdistribution hazard ratio (aSHR) was 0.82 [95% confidence interval (CI), 0.72 to 0.94] for every 5 ml/min/1.73 m increase in eGFR. In addition, higher BMI ( = 0.01) was associated with a lower risk of TB infection and the aSHR was 0.91 (95% CI, 0.85 to 0.98) for every 1 kg/m increase in BMI. Renal function and body mass index are independently associated with the risk of tuberculosis infection in patients with chronic kidney disease not receiving dialysis.
接受维持性肾脏替代治疗的慢性肾脏病（CKD）患者发生结核（TB）感染的风险更高。未接受透析的CKD患者发生TB感染的风险尚不清楚。我们开展本研究以检验TB感染与肾功能呈负相关这一假设。纳入2003年1月至2014年5月在中国医科大学附属第一医院住院的1-5期非透析CKD患者，并对其进行前瞻性随访，直至诊断为TB、死亡、失访或至2014年12月。采用带时变协变量的竞争风险回归分析对TB感染的危险因素进行分析。开始透析和患者死亡被视为竞争事件。记录入组时患者的估计肾小球滤过率（eGFR）和体重指数（BMI）。他们的中位随访时间为1.4年。在7221例患者中，114例被确诊为TB感染。较高的eGFR与较低的TB感染风险相关（<0.01）。eGFR每增加5 ml/min/1.73 m²，校正后亚分布风险比（aSHR）为0.82[95%置信区间（CI），0.72至0.94]。此外，较高的BMI（=0.01）与较低的TB感染风险相关，BMI每增加1 kg/m²，aSHR为0.91（95%CI，0.85至0.98）。肾功能和体重指数与未接受透析的慢性肾脏病患者发生结核感染的风险独立相关。
