Incidence of pulmonary tuberculosis in chronic renal failure patients on dialysis vs non dialysis in rural population

 

 

Abstract              Background: The incidence of CKD is rising in rural populations in our country which is proving a heavy burden on healthcare and economy. Due to reduced awareness about the disease process, the complications are more particularly in this group of patients. Tuberculosis is one of the most common infections worldwide which affects almost one third of the world population. The risk of active tuberculosis is more in patients with reduced immunity like HIV, organ transplant etc. End stage renal disease particularly uremia is a immunosuppressive condition. It affects both innate immunity and adaptive immunity by affecting the motility of T cells and their ability to kill ingested intracellular pathogen. Aim: The aim of the study was to identify the risk of TB in CKD patients and the impact of hemodialysis on the affection of tuberculosis. Methodology: The study was done in a tertiary care hospital in a rural setup over a period of 1 year from August 2015 to July 2016. The study included 78 patients and were divided into 3 groups. Consent was taken. 1st group had 25 patients of ESRD who were not undergoing dialysis. 2nd group had 23 patients undergoing dialysis since less than 1 year. 3rd group had 40 patients with regular dialysis less than thrice per week since more than 1 year. All patients were subjected to the following: ¹Complete history, physical examinations, ²Routine blood investigations CBC, LFT KFT, ³CXR-PA view ⁴Sputum examination in relevant patients with CXR showing suspicion of pulmonary tuberculosis ⁵Pleural fluid examination in relevant cases with routine cytological, ADA examinations, ⁶ BAL and gene Xpert in 4 patients with Xray suggestive of tuberculosis but Zn staining negative. ⁷Tuberculin testing was done in all subjects, ⁸USG Abdo to rule out abdominal tuberculosis, All the information was subjected to statistical analysis, Conclusion: We found that there was an increased risk of Tb in CKD patients. Though hemodialysis reduces uremia, it does not seem to reduce the risk of tuberculosis in CKD patients. The patients with CKD and tuberculosis had statistically significant levels of S.creat and Blood urea nitrogen as compared to non TB patients with CKD .

Key Word: pulmonary tuberculosis, chronic renal failure.