Abstract: FR-PO760
ESRD and a Risk of Tuberculosis: A Nationwide Population-Based Cohort Study
Session Information
- Dialysis: Inflammation and Infection
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kwon, Soon Kil, Chungbuk National University College of Medicine, Cheongju, Chungbuk, Korea (the Republic of)
- Kim, Hye-Young, Chungbuk National University College of Medicine, Cheongju, Chungbuk, Korea (the Republic of)
- Kim, Sun Moon, Chungbuk National University Hospital, Cheongju, Korea (the Republic of)
- Cho, Hyunjeong, Chungbuk National University Hospital, Cheongju, Korea (the Republic of)
Background
The converging epidemics of tuberculosis (TB) and end-stage renal disease (ESRD) have generated a significant public health burden and difficulties in controlling TB, although the relationship between these conditions remains poorly understood. This nationwide propensity score-matched cohort study aimed to assess the rateof developing TB among patients receiving dialysis for ESRD.
Methods
The Korean national health insurance database was used to identify patients receiving dialysis for new-onset ESRD during 2004–2013, who were matched to an equivalent number of non-dialysis subjects. We also collected data from the KNHIS National Sample Cohort (NSC), which is stored in the same database. The KNHIS-NSC included approximated 1,000,000 individuals (2.2% of the total Korean population) and was created by sampling the records of the National Health Information database. The incidences of active TBin the dialysis and control cohorts during 2004–2013 were identified using International Classification of Disease, tenth revision (ICD-10) codes (A15–19, U88). The diagnosis of active TBwas then confirmed based on simultaneous prescriptions for ≥2 anti-tuberculosis drugs during a 30-day period. The incidences of TB in the ESRD and control cohorts were calculated for 2004–2013, and multivariable Cox proportional hazards modelwas used to evaluate the ESRD-related risk of developing TB.
Results
During 2004–2013, 59,584 patients received dialysis for newly diagnosed ESRD, which was associated with a significantly higher risk of TB than among the controls (incidence rate ratio: 4.80). The cumulative TB incidence was significantly higher in the dialysis cohort than in the control cohort (p<0.0001; log-rank test), and subgroup analyses revealed similar results for both hemodialysis and peritoneal dialysis (both p<0.0001; log-rank test). However, there was no significant difference in the risk of TB between the hemodialysis and peritoneal dialysis subgroups(p= 0.67; log-rank test). The ESRD cohort had an independently elevated risk of TB (hazard ratio: 4.39, 95% confidence interval: 3.60–5.37).
Conclusion
Similar to the findings of previous studies, we found that patients receiving dialysis for ESRD had an elevated risk of TB. These results highlighted the need of detailed and well-organized guidelines for TB screening among patients with ESRD.