Introduction:
The relationship between active Tuberculosis (TB) and chronic kidney disease (CKD) remains largely unexplored. There is abundance of literature on the increased frequency of TB infection in patients with CKD, but limited research on the role TB plays in the causation of CKD. TB, although an uncommon cause of progressive renal failure, is a potentially preventable and easily treatable condition. This study intended to identify the prevalence of CKD in patients with TB in Nepal and evaluate the factors associated with CKD in TB patients.
Methods:
A community based cross sectional study was conducted on all TB patients above 18 years attending the Directly Observed Treatment Short-Corse (DOTS) clinics in a single District of Eastern Nepal after ethical approval. A total of 663 patients were enrolled in the final analysis based on sample size calculation with 2.2% dropout rate at 95% CI with 15% margin of error. Validated questionnaires were used for face-to-face interviews, physical examination, and biophysical measurements after obtaining an informed written consent. Sample of blood and urine were also collected for evaluation in the laboratory. Urine Albumin Creatinine Ratio (uACR) was determined and eGFR (mL/min per 1.73 m2) calculated with the CKD-EPI 2021 equation. Outcomes included proteinuria (uACR>3 mg/mmol) and eGFR<60 ml/min/1.73 m2. Analysis was done by Pearson chi-square test followed by binary logistic regression at 95% CI by the backward conditional method for adjusted Odds Ratios (aOR).
Results:
CKD (uACR>3 mg/mmol and/or eGFR<60 ml/min/1.73 m2) was prevalent in 25.3% (CI: 23.6 – 27.0) of the TB patients, in contrast to the findings of a study conducted in the same area, on the general population with a prevalence of 10.6%.Another one fourth (24.9%) of the TB subjects in our study had their eGFR in the 60-90 ml/min/1.73 m2 range and constituted the at-risk population for renal impairment. Age 60 years or more, no formal schooling, having a history of Diabetes, high blood pressure or high random blood glucose were some of the factors significantly associated with CKD after adjusting for all the statistically significant variables with p<0.05
Conclusions:
This study found a high prevalence (25.3%) of CKD in TB patients, which is more than two times the prevalence in the general population. We identified factors such as age more than 60 years, absence of formal schooling, high blood pressure, and presence of Diabetes Mellitus to be significantly associated with the presence of CKD. A further quarter (24.9%) of the study subjects had their eGFR in the 60-90 ml/min/1.73 m2 range making them at-risk for further renal impairment due to added insults of anti-TB drugs and other factors. Longitudinal studies are required to assess the effects of TB infection and treatment on their kidney function.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.