Xiao Jing, Ge Jianjian, Zhang Dingxin, Lin Xinqiang, Wang Xiaoshuang, Peng Li, Chen Liqun
Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Department of Respiratory, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Int J Gen Med. 2022 Aug 19;15:6661-6669. doi: 10.2147/IJGM.S367090. eCollection 2022.
The diverse manifestations of tuberculosis (TB) in chronic kidney disease (CKD) patients can cause difficulty in diagnosis, delayed treatment, even death. Therefore, this study investigated the clinical characteristics and the risk factors for mortality in CKD patients with TB.
This retrospective study included 167 patients diagnosed with active TB at two tertiary medical centers in Chongqing within six years. Clinical characteristics and outcomes of anti-TB treatment in patients with and without CKD were collected, and the predictive mortality values of variables were analyzed.
Of the 167 patients, 66.7% (44/66) hemodialysis (HD), 41.1% (21/51) pre-HD, and 32.0% (16/50) non-CKD patients had extrapulmonary TB. The pleura and lymph node were the common sites in CKD patients. Clinical presentations of cough and hemoptysis in CKD patients were less common than those in non-CKD patients, 13.7% (16/117) of CKD patients even not having any clinical symptoms. The positive rates of tuberculin skin test, TB-polymerase chain reaction and acid-fast bacilli in sputum in HD patients were lower than those in pre-HD and non-CKD patients (<0.05). CKD patients were more prone to gastrointestinal and neurological side effects during anti-TB treatment. The mortality rates of non-CKD, pre-HD and HD patients was 6.1%, 31.9% and 37.3%, respectively. Multivariate Cox analysis revealed that age≥40 years (HR: 5.871; =0.019), hypoalbuminemia (HR:2.879; =0.004), CKD stage 4-5 (HR:4.719; =0.018) and HD (HR:6.13; =0.005) were associated with mortality.
CKD patients with TB have atypical clinical manifestations and high mortality. Age, hypoalbuminemia, CKD stage 4-5, and HD were independent predictors of mortality.
慢性肾脏病（CKD）患者中结核病（TB）的多样表现可导致诊断困难、治疗延误甚至死亡。因此，本研究调查了CKD合并TB患者的临床特征及死亡风险因素。
这项回顾性研究纳入了6年内于重庆两家三级医疗中心确诊为活动性TB的167例患者。收集了有或无CKD患者抗结核治疗的临床特征及结局，并分析了各变量的预测死亡值。
167例患者中，66.7%（44/66）血液透析（HD）患者、41.1%（21/51）HD前患者和32.0%（16/50）非CKD患者有肺外结核。胸膜和淋巴结是CKD患者的常见受累部位。CKD患者咳嗽和咯血的临床表现不如非CKD患者常见，13.7%（16/117）的CKD患者甚至没有任何临床症状。HD患者结核菌素皮肤试验、TB聚合酶链反应及痰涂片抗酸杆菌阳性率低于HD前和非CKD患者（<0.05）。CKD患者在抗结核治疗期间更容易出现胃肠道和神经方面的副作用。非CKD、HD前和HD患者的死亡率分别为6.1%、31.9%和37.3%。多因素Cox分析显示，年龄≥40岁（HR：5.871；P=0.019）、低白蛋白血症（HR：2.879；P=0.004）、CKD 4-5期（HR：4.719；P=0.018）及HD（HR：6.13；P=0.005）与死亡相关。
CKD合并TB患者有非典型临床表现且死亡率高。年龄、低白蛋白血症、CKD 4-5期及HD是死亡的独立预测因素。
