INCIDENCE OF TUBERCULOSIS DISEASE IN A HAEMODIALYSIS POPULATION IN SOUTH INDIA – A SINGLE CENTRE EXPERIENCE OF NINE YEARS

 

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INCIDENCE OF TUBERCULOSIS DISEASE IN A HAEMODIALYSIS POPULATION IN SOUTH INDIA – A SINGLE CENTRE EXPERIENCE OF NINE YEARS

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Kedhara Gowri
Sainath
Kedhara Gowri Sainath kedha.sai@gmail.com JIPMER Nephrology Puducherry India *
Devan D drdev2701@gmail.com JIPMER Nephrology Puducherry India -
Karthikeyan Manoharan drkarthikmanoharan@gmail.com JIPMER Nephrology Puducherry India -
Sabarinath Shanmugham sabarivenus@gmail.com JIPMER Nephrology Puducherry India -
Swathy Raju swathiraju7777@gmail.com JIPMER Nephrology Puducherry India -
Priyamvada PS priyamvadaps@gmail.com JIPMER Nephrology Puducherry India -
Sreejith Parameswaran sparameswaran@jipmer.ac.in JIPMER Nephrology Puducherry India -
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The incidence of Tuberculosis (TB) is 8 to 25 times higher, and TB-associated mortality is higher in CKD patients compared to general population. The national TB elimination program (NTEP) in India recommends testing dialysis patients for TB infection (TBI) and offering TB Prevention treatment (TPT) if having TBI. However, haemodialysis (HD) patients are infrequently tested for TBI. We studied the incidence of TB Disease (TBD) over a nine-year period in our haemodialysis centre

All individuals enrolled at our HD centre (a 25-station facility started in 2016) between 1st May 2016 to 31st May 2025, aged >18 years and on regular HD for at least 3 months were included. People with TBD at enrolment for HD and those with missing records were excluded. Using the hospital’s electronic medical records and case records, demographic, clinical data as well as data regarding TB diagnosis and outcome and previous hospitalizations was recorded

During the study period 338 individuals were enrolled; after excluding those with incomplete records (n=81) and those with TBD at the time of enrolment (n=7), 250 patients were analysed. Twenty patients [8%] developed TBD in the study period; 16 had extra-pulmonary TB. The incidence of TBD was 800 cases per 10,000 dialysis patients over 9 years, or 247 cases per 10,000 patient-years.

Their mean age was 39.8 ± 11.1 (range 21-62), and 74% were men. Comorbidities – DM 01, HFrEF 01, PLHA 01, immunuosuppression in the past 01. Six had tuberculous lymphadenitis, 5 pleural TB, 3 skeletal TB, 1 abdominal and 1 pericardial TB. Two of the 20 patients died while on therapy, and 1 was lost to follow-up. One patient is on therapy at the last follow-up. The remaining had achieved a cure. 

The Incidence of TB Disease remains high in the HD population, with a high proportion of extra-pulmonary TB. Measures like active screening for TBI and offering TPT for people with TBI need to be implemented in an effort to reduce the incidence of TBD in the HD population.  

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