Diagnosis and management of tuberculosis in peritoneal dialysis

Abstract

Infectious complications represent the second cause of death in chronic renal failure, in particular tuberculosis (Tb), which remains more frequent in dialysis patients. The aim of our work is to determine the prevalence of Tb in our patients on peritoneal dialysis (PD) and to analyze the clinical, paraclinical and evolutionary profile of this infection. This is a retrospective cross-sectional study, including PD patients diagnosed with Tb. We analyzed their clinical and paraclinical profile, the diagnosis and localization of Tb, as well as the evolution under treatment. We retained 12 cases of Tb among the 228 patients followed in PD (5.26%) from 2006 to 2022, with an M/F sex ratio of 0.7 and an average age of 52.7 ± 10 years. The median time between the start of PD and the diagnosis of Tb was 21 months [5 - 37]. The diagnosis of Tb was retained with certainty in 7 cases, based on bacteriological and/or histological evidence. The diagnosis was presumptive in 5 cases on a bundle of clinical and paraclinical arguments. The localization of Tb is pulmonary in 4 cases and extra-pulmonary in 8 cases including 3 cases of tuberculous peritonitis. Anti-bacillary treatment is started after a median delay of 20 days [9-37] after the onset of symptoms. This treatment was complicated by 2 cases of drug-induced hepatitis and 1 case of polyneuritis. The evolution is marked by healing in 11 patients. Regarding tuberculous peritonitis, the catheter was removed in one patient and maintained in the other two cases with favorable outcome. In PD, the diagnosis of Tb is often difficult and extra-pulmonary involvement is more frequent.

Keywords

• peritoneal dialysis
• peritonitis
• tuberculosis
• anti-bacillary