Burden of Tuberculosis in End Stage Renal Disease Patients Undergoing Maintenance Hemodialysis: A Multicenter Study and Experience from Ethiopian Dialysis Setting

Abstract

Eyob Beyene,1 Zekewos Demissie,2 Wubshet Tolossa Jote,3 Seyfemichael Getachew,3 Addisu Melkie Ejigu,4 Wondwossen Amogne Degu1 1Department of Internal Medicine, Division of Infectious Disease, Addis Ababa University, Addis Ababa, Ethiopia; 2Department of Internal Medicine, Lancet General Hospital, Addis Ababa, Ethiopia; 3Department of Internal Medicine, Division of Nephrology, St. Paul Millennium Medical College, Addis Ababa, Ethiopia; 4Department of Internal Medicine, Division of Nephrology, Addis Ababa University, Addis Ababa, EthiopiaCorrespondence: Eyob Beyene, Email [email protected]: Patients with end stage renal disease (ESRD) are at a higher risk of developing tuberculosis (TB) due to the immunosuppressed state along with concomitant comorbidities and socioeconomic and demographic factors. Data on the prevalence of tuberculosis in ESRD are scarce despite the high burden of the disease in developing nations.Methods: A multicenter, cross-sectional study was conducted at eight dialysis centers in Addis Ababa on the prevalence of TB among CKD patients on maintenance hemodialysis from August 2022 to October 2022 G.C. The study enrolled 263 participants selected by systematic random sampling. Data were collected by reviewing the patient’s electronic medical records. The Collected data were analyzed using SPSS version 26.0.Results: Our study found a 27% prevalence of TB in patients with ESRD receiving maintenance hemodialysis (MHD). Pulmonary tuberculosis was the most prevalent form, and lymphadenitis was the most common extra-pulmonary tuberculosis (EPTB). Only 5.6% of the study participants had microbiologic evidence of TB. Chemistry and cytological studies from pleural fluid and imaging evidences were commonly used diagnostic modalities. The presence of HIV infection, longer duration of dialysis (> 1 year), and contact history with a known TB patient were all significantly associated with higher prevalence of TB among the study participants.Conclusion: Although there is a strong association between TB and CKD, there are no local data from Ethiopia. Our study identified a higher prevalence of TB among CKD patients on MHD. Thus, maintaining a high index of suspicion and early diagnosis and treatment of TB among ESRD patients on MHD and use of TB preventive therapy (TPT) is important in decreasing morbidity and mortality.Keywords: dialysis, end stage renal disease, tuberculosis, extrapulmonary TB

Keywords

• dialysis
• end stage renal disease
• tuberculosis
• extrapulmonary tb