The value of tuberculin skin testing in haemodialysis patients

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2004-02, Vol.19 (2), p.433-438
• Main Authors: Wauters, Anne, Peetermans, Willy E., Van den Brande, Paul, De Moor, Bart, Evenepoel, Pieter, Keuleers, Hilde, Kuypers, Dirk, Stas, Koen, Vanwalleghem, Johan, Vanrenterghem, Yves, Maes, Bart D.
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Belgium - epidemiology; Biological and medical sciences; Comorbidity; Emergency and intensive care: renal failure. Dialysis management; Female; Glomerulonephritis; haemodialysis; Health Services Needs and Demand; Humans; Incidence; Intensive care medicine; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - therapy; Male; Mass Screening - methods; Medical sciences; Middle Aged; Multivariate Analysis; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Probability; Prospective Studies; Renal Dialysis - adverse effects; Renal Dialysis - methods; Reproducibility of Results; Risk Assessment; Sex Distribution; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; tuberculin skin test; Tuberculin Test; tuberculosis; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - epidemiology
• ISSN: 0931-0509; 1460-2385; 1460-2385
• DOI: 10.1093/ndt/gfg569

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.