Tuberculosis in Hemodialysis Patients in Area of High Incidence of Mycobacterium tuberculosis and Human Immunodeficiency Virus Infection

BACKGROUND: Hemodialysis (HD) patients have an increased incidence of tuberculosis (TB), which may be due to decreased cellular immunity, the presence of malnutrition, and the use of immunosuppressive drugs. Poor living conditions, overcrowding, and human immunodeficiency virus (HIV) infection could be considered added risk factors. This study analyzed the incidence and clinical characteristics of TB among HID patients in an area where TB and HIV infection have a high prevalence. METHODS: In this multicenter study, 1266 patients (663 men and 603 women) ages 20-91 years (46.1 +/- 16.8 years) from 8 HD centers in different cities of Rio de Janeiro State, Brazil, were studied. HIV-infected patients were excluded from the study. RESULTS: TB was observed in 30 patients (2.3%), the pulmonary type in 11 (36.6%) and the extrapulmonary type in 19 (63.4%). The time of emergence during the HID period was very wide (2-117 months). All patients presented with unexplained fever and general symptoms such as weight loss, fatigue, and malaise in variable frequencies. The purified protein derivative (tuberculin) test was positive in only 16.6% of TB patients. They were treated with a combination of rifampicin (450-6000 mg/day), isoniazid (200-300 mg/day), and pyrazinamide (1.5-2 g/day); only 1 patient died, and 2 underwent a successful renal transplantation after the treatment. CONCLUSIONS: TB incidence in HD patients was higher than in the general population (p < 0.0001) with a relative risk (RR) of 19.68 (13.81 <RR <29.03), which points to the urgent need to investigate TB in all uremic patients with unexplained fever, continuous nonspecific symptoms, or when TB is suspect, whereas the response to therapy is directly dependent on early diagnosis, and the specific treatment may offer HD patients a good prognosis.