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Epidemiology, detection, and management of tuberculosis among end-stage renal disease patients

Published online by Cambridge University Press:  20 September 2018

Reiko C. Okada ,
Pennan M. Barry ,
Jacek Skarbinski  and
Amit S. Chitnis
Reiko C. Okada
Affiliation:
Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
Pennan M. Barry
Affiliation:
Tuberculosis Control Branch, Division of Communicable Disease Control, California Department of Public Health, Richmond, California
Jacek Skarbinski
Affiliation:
Kaiser Permanente Northern California, Division of Infectious Diseases, Oakland, California
Amit S. Chitnis*
Affiliation:
Tuberculosis Control Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California
*
Author for correspondence: Amit S. Chitnis MD, MPH, 1000 San Leandro Blvd, First Floor, San Leandro, CA 94577. E-mail: Amit.Chitnis@acgov.org
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Abstract

Tuberculosis (TB) remains an important problem among end-stage renal disease (ESRD) patients. We reviewed the epidemiology of TB and ESRD, investigations of TB exposures in US dialysis facilities, and published guidelines to inform screening and treatment practices among US ESRD patients. Compared to TB in the general population, ESRD patients have 6–25-fold higher TB incidence rates, and mortality during treatment is 2–3-fold higher. Most TB cases among ESRD patients (~90%) occur among non–US-born persons, and an analysis of genotyping data suggests that 80% of all cases result from latent TB infection (LTBI) reactivation. Published TB contact investigations in dialysis facilities have reported cases among ESRD patients and healthcare workers. However, transmission of TB is rare: there were no reports of secondary cases of TB because of exposure to an index-case patient and there were few TB infections, which was demonstrated by low occurrence of newly positive tuberculin skin tests (12%–16%) and conversions (8%–17%) among contacts. Targeted TB education, screening, and treatment for ESRD patients at highest risk for TB exposure (eg, non–US-born persons), using interferon-gamma release assays and short course LTBI regimens (ie, isoniazid-rifapentine weekly for 12 weeks or rifampin daily for 4 months) may be an effective overall strategy for reducing TB burden in ESRD patients.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1367 - 1374
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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