The value of tuberculin skin testing in haemodialysis patients.

Abstract

BACKGROUND:

Chronic haemodialysis patients are at increased risk for developing tuberculosis (TB). Appropriate screening methods to detect latent Mycobacterium tuberculosis infection are required. The aim of this prospective multi-centre study was to evaluate the tuberculin skin test (TST) as a screening method for detection of M.tuberculosis infection in haemodialysis patients.

METHODS:

A total of 224 patients in two haemodialysis centres were prospectively tested, using 2 units of tuberculin PPD RT23. Up to three booster injections were given with a 7 day interval to patients not responding to the previous test. The results were compared with clinical and radiological data.

RESULTS:

The cumulative prevalence of a positive TST was 14.7% for the first test, 27.8% for the second test and 32.6% for the fourth test. There was no influence of age, gender, haemodialysis centre, dialysis efficiency, nutritional state, levels of zinc, vitamin D therapy, primary renal disease, (previous or active) immunosuppressive therapy or response to hepatitis B vaccination. There was a significant, but weak, correlation between TST positivity and a history of positive TST or TB. Chest radiography and positive TST were not correlated, yet a positive chest X-ray increased the detection of patients with latent M.tuberculosis infection up to 47.8%.

CONCLUSIONS:

In haemodialysis patients, a positive response of >30% to repeated TST was obtained. Two consecutive TSTs were sufficient to recruit most of the booster reactions. Since only a weak correlation was found with anamnestic data, regular TST evaluation in combination with a chest X-ray, is a useful tool to detect infection with M.tuberculosis in haemodialysis patients.

• Authors: Anne Wauters, Willy E Peetermans, Paul Van den Brande, Bart De Moor, Pieter Evenepoel, Hilde Keuleers, Dirk Kuypers, Koen Stas, Johan Vanwalleghem, Yves Vanrenterghem, Bart D Maes
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 19 Issue 2 Pg. 433-8 (Feb 2004) ISSN: 0931-0509 [Print] England
• PMID: 14736970 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Analysis of Variance
• Belgium (epidemiology)
• Comorbidity
• Female
• Health Services Needs and Demand
• Humans
• Incidence
• Kidney Failure, Chronic (diagnosis, epidemiology, therapy)
• Male
• Mass Screening (methods)
• Middle Aged
• Multivariate Analysis
• Probability
• Prospective Studies
• Renal Dialysis (adverse effects, methods)
• Reproducibility of Results
• Risk Assessment
• Sex Distribution
• Statistics, Nonparametric
• Tuberculin Test
• Tuberculosis, Pulmonary (diagnosis, epidemiology)