Abstract: TH-PO901

Latent Tuberculosis in Dialysis Patients: Prevalence, Risk Factors, and Inflammatory Markers

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Dahlan, Randah Abdullah, Davita KSA, Jeddah, Saudi Arabia
  • Shaheen, Mahmoud Maamoun, Davita KSA, Jeddah, Saudi Arabia
  • Abd_elkhalek, Mostafa Abd_elsalam, Davita KSA, Jeddah, Saudi Arabia
  • Alsuwaida, Abdulkareem, Davita KSA, Jeddah, Saudi Arabia
Background

Dialysis patients are more susceptible to infections than the general population as they have a dysfunctional immune system.Therefore, various prevention and screening strategies must be implemented in dialysis units to decrease the rate of infection. Screening for latent tuberculosis (LTB), is an important preventative strategy in countries with moderate or high disease burden. We conducted this continuous quality improvement project to ensure the process of screening for LTB is being appropriately implemented as per our dialysis unit policy,to know the prevalence of LTB using interferon—γ release assay (IGRA), and to determine if certain patients’ variables may play a role as a risk factor or as a disease marker.

Methods

We reviewed the clinical data of all patients dialyzing at DaVita dialysis units in Jeddah, SA to abstract data about IGRA test, patients demographic, laboratory, radiological and clinical status.

Results

302 dialysis patients were screened for LTB using the IGRA, and 92 patients (30.5%) were positive. All positive patients were assessed for presence or absence of suspicious symptoms and a chest X-ray (CXR) was obtained to rule out active disease. Active TB was thought to be unlikely in all patients. When patients with positive test were compared to those who tested negative, they were older (54.74 ± 16.05 versus 50.4 ± 16.2 years,p value = 0.033), more likely to have had a previous history of TB (p value = 0.0014), less likely they had received the BCG vaccine in the past (p value = 0.0003), and had a higher ferritin (p value = 0.45). There was no difference between the 2 groups in terms of sex, dialysis vintage, the background rate of DM, HCV, or HBV, lymphocytes count, neuropils, platelets, neutrophil to lymphocyte ratio, platelets to lymphocytes ratio, transferrin saturation, or albumin level.

Conclusion

Elderly, those with a past history of TB, and those who have no past history of BCG vaccination are all potentially at risk of LTB. Although many inflammatory markers are not characteristically high in patients with LTB, high ferritin level is commonly seen. This is the first study to describe simple inflammatory markers in dialysis patients with LTB. Screening dialysis patients who have persistent unexplained high ferritin level for LTB should be considered in appropriate settings.