慢性肾脏病行常规血液透析患者中潜伏性结核的危险因素

Risk factors of latent tuberculosis among chronic kidney disease with routine haemodialysis patients.

作者信息

Bandiara Ria, Indrasari Astried, Dewi Rengganis Anggi, Sukesi Lilik, Afiatin Afiatin, Santoso Prayudi

机构信息

Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin General Hospital, Bandung, Indonesia.

Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Mulawarman/Abdul Wahab Sjarani Hospital, Samarinda, Indonesia.

出版信息

J Clin Tuberc Other Mycobact Dis. 2022 Feb 22;27:100302. doi: 10.1016/j.jctube.2022.100302. eCollection 2022 May.

DOI:10.1016/j.jctube.2022.100302

PMID:35243009

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8886030/

Abstract

INTRODUCTION

Since immune system alteration occurs, chronic kidney disease (CKD) on routine haemodialysis (HD) patients have a greater risk for latent tuberculosis (LTB). LTB needs special attention so that it does not develop into an active form, because infection in CKD patients increases the mortality. This study aims to determine the risk factors that associated with LTB among CKD on routine HD patients.

METHODS

This was a cross-sectional study conducted in Haemodialysis Unit, Hasan Sadikin General Hospital, Bandung. The subjects were recruited from March-May 2020. Subjects aged > 18 years at least have undergoing HD in 3 months and twice a week HD were included in this study. Patients with active tuberculosis (TB) suspected, malignancy, or immunocompromised were excluded. LTB was diagnosed using interferon-γ release assays (IGRA). All data including age, sex, CKD etiologies, smoking status, HD adequacy that assessed using KT/V and urea reduction ratio (URR), and contact status with TB patients were obtained and recorded in case report form.

RESULTS

A total of 120 subjects were involved. LTB based on IGRA was occurred in 39.2% subjects, while 56.7% and 4.1% subjects had negative and indeterminate IGRA, respectively. Adequacy of HD based on KT/V value was not significantly different between positive and negative IGRA subjects. Positive IGRA subjects had lower URR (p = 0.042). Smoking status had significant association with LTB (OR = 2.5[95%CI 1.2-5.4, p = 0.017). Furthermore, URR < 73% also had significant association with LTB (OR = 2.6[1.2-5.6, p = 0.013).

CONCLUSION

Smoking status and HD adequacy based on URR < 73% are associated factors that contribute to LTB among CKD on HD patients.

摘要

引言

由于免疫系统发生改变，接受常规血液透析（HD）的慢性肾脏病（CKD）患者发生潜伏性结核病（LTB）的风险更高。LTB需要特别关注，以免发展为活动型，因为CKD患者的感染会增加死亡率。本研究旨在确定常规HD的CKD患者中与LTB相关的危险因素。

方法

这是一项在万隆哈桑·萨迪金综合医院血液透析科进行的横断面研究。研究对象于2020年3月至5月招募。年龄大于18岁、至少接受3个月HD且每周进行两次HD的患者纳入本研究。疑似活动性结核病（TB）、恶性肿瘤或免疫功能低下的患者被排除。使用干扰素-γ释放试验（IGRA）诊断LTB。获取所有数据，包括年龄、性别、CKD病因、吸烟状况、使用KT/V和尿素清除率（URR）评估的HD充分性以及与TB患者的接触状况，并记录在病例报告表中。

结果

共纳入120名研究对象。基于IGRA诊断，39.2%的研究对象发生LTB，而56.7%和4.1%的研究对象IGRA结果分别为阴性和不确定。基于KT/V值的HD充分性在IGRA阳性和阴性研究对象之间无显著差异。IGRA阳性的研究对象URR较低（p = 0.042）。吸烟状况与LTB有显著关联（OR = 2.5[95%CI 1.2 - 5.4，p = 0.017]）。此外，URR < 73%也与LTB有显著关联（OR = 2.6[1.2 - 5.6，p = 0.013]）。