Introduction:
Immunocompromised individuals are known to be susceptible to develop Tuberculosis (TB). Facilitation of integrated TB services at tertiary facilities for improving TB diagnosis amongst chronic kidney disease (CKD) patients (Project FOSTER) introduces uniform screening for active TB and TB infection (TBI) in selected tertiary care hospitals.
Methods:
A public sector tertiary care centre was identified in New Delhi, India, with daily Nephrology out-patient (OPD) visitors between 100 to 150. A standard WHO four symptom screen W4SS symptom (Fever/ Cough/ Weight Loss/ Night Sweats), chest X-ray (CXR) and GeneXpert/smear microscopy-based screening pathway was operationalised at the facility depending on NAAT cartridge availability. An OPD-based intervention was setup wherein specialised staff were stationed inside OPD rooms to direct first-time patients towards hospital CXR facilities after obtaining informed consent. CXR negative patients were offered Cy-TB, a tuberculin-skin based test to detect latent TBI.
Results:
In this study, we screened 2557 patients for W4SS symptoms and using CXRs. We were able to capture around 95% of the target OPD patients, including 62 glomerulonephritis (2.4%) and 37 Transplant OPD patients (1.4%). Out of these patients, 216 (8.44%) were presumptive positive on CXR, and five cases were found to be positive for Mycobacterium TB (4.6% NAAT positive and 1.8% AFB smear positive out of those whose samples were collected). Twenty patients were put on anti-tubercular treatment (ATT) based on clinical suspicion. Overall, the prevalence of TB was 977 per 100,000 CKD patients (compared to a prevalence of 534 per 100,000 general population in New Delhi, India). Two glomerulonephritis patients (3.2%) and one transplant patient (2.7%) were also put on ATT.
Conclusions:
The prevalence of TB among CKD patients is higher than general population in New Delhi, India. This is the first significant effort at quantifying TB load amongst CKD patients in India. Greater action is required to both identify TB patients in this cohort as well as sensitising nephrologists to modern TB practices.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.