Sturman Joseph, Baharani Jyoti, Ashman Jed, Harper Lorraine, Cunningham Adam F, Dedicoat Martin, O'Shea Matthew K
Department of Immunology and Immunotherapy, School of Infection, Inflammation and Immunology, College of Medicine and Health, University of Birmingham, Birmingham, UK.
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Clin Kidney J. 2025 Jun 19;18(7):sfaf197. doi: 10.1093/ckj/sfaf197. eCollection 2025 Jul.
Tuberculosis (TB) and chronic kidney disease (CKD) represent an extant local and global syndemic, with TB incidence rates in the UK end-stage renal failure population far surpassing those of the general population in endemic countries. Patients with CKD generally have latent TB reactivation, rather than infection, which presents with atypical, non-pulmonary presentations leading to late diagnosis, poorer outcomes and a high risk of widespread transmission through haemodialysis units. There is therefore a need to consider latent TB infection screening in the CKD population. However, there is widespread variation in local screening practices in the UK due to the challenge of diagnosing latent TB in CKD, and the absence of robust evidence-based guidelines. There is also concern that although a screening programme may have significant public health benefit, it may cause harm to the individual patient through adverse effects of treatment. In this review, we present the current evidence for latent TB infection screening in CKD, including the evidence of benefit and harm to the individual and the public. We also review current practices in the UK and present survey data from renal units in England demonstrating the diversity of policies currently in place. We advocate screening for latent TB in all CKD patients commencing dialysis and we highlight the pressing research questions that need to be urgently answered to help move towards a cohesive national policy to help drive evidence-based consistent care.
结核病（TB）和慢性肾脏病（CKD）构成了一种现存的局部和全球综合征，在英国终末期肾衰竭人群中的结核病发病率远远超过了流行国家普通人群的发病率。CKD患者一般是潜伏性结核再激活，而非感染，其表现为非典型的、非肺部症状，导致诊断延迟、预后较差，且通过血液透析单位广泛传播的风险很高。因此，有必要考虑对CKD人群进行潜伏性结核感染筛查。然而，由于在CKD中诊断潜伏性结核存在挑战，且缺乏有力的循证指南，英国各地的筛查做法存在广泛差异。人们还担心，尽管筛查计划可能具有重大的公共卫生益处，但它可能会因治疗的不良反应对个体患者造成伤害。在本综述中，我们展示了目前CKD中潜伏性结核感染筛查的证据，包括对个体和公众的益处与危害的证据。我们还回顾了英国目前的做法，并展示了来自英格兰肾脏单位的调查数据，以说明目前现行政策的多样性。我们主张对所有开始透析的CKD患者进行潜伏性结核筛查，并强调迫切需要回答的紧迫研究问题，以帮助形成一项连贯的国家政策，推动循证的一致护理。
