Association between chronic kidney disease and tuberculosis - A prospective study form a tertiary care teaching hospital

Background: Chronic kidney disease (CKD) is emerging as a major public health problem in India. The links between CKD and Tuberculosis have long been established but the exact nature of interaction is poorly understood. Bulk of the association was studied on subjects undergoing dialysis or renal transplantation, with limited studies on CKD subjects without dialysis. The amount of data is further scarce on Indian population. Hence the present study was conducted to assess the prevalence and profile of pulmonary tuberculosis in CKD patients presenting to a tertiary care teaching hospital in south India Materials and methods: The present study was a prospective study of all the CKD patients presenting to a tertiary care teaching hospital in south India diagnosed with chronic renal failure, as per the hospital protocol. The data was collected from the prospective case records of all the CKD patients diagnosed between April 2015 to 2017. Results: There were a total of 2927 patients with CKD, who satisfied the inclusion criteria and were included in the study. The average prevalence of tuberculosis among the study population was 1.16%. The age distribution of the tuberculosis cases have shown that highest proportion of subjects (47.05%) was aged above 60 years. There was a high male preponderance in study population, as 88.23% affected by tuberculosis were males and 11.77% were females. The most common x-ray finding was infiltration seen in 12 (35.29%) of the patients with TB. Cavities were present in 14 (41.17%) subjects- fibrosis was seen in 4 (11.76%) subjects. There was no statistically significant difference in blood urea nitrogen (BUN) or serum creatinine values between the two groups (P value > 0.05) Conclusion: Chronic Kidney disease patients are at high risk of tuberculosis, as the prevalence in CKD patients is higher than that of general population. Considering the alterations in the immune system, the immunological response of the host to tuberculosis infection is altered in CKD patients- this makes routine investigations like sputum examination and manteaux test less reliable in CKD patients. Chest-X-ray may be more useful in these patients.