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Latent TB in Patients with Chronic renal failure- results from a national survey.
Background: Patients with chronic renal failure are especially prone to infections due to dampened
adaptive immunity. Tuberculosis in particular poses a significant risk including the potential for antiTB drugs to further worsen the prognosis of patients. It is thus imperative that TB is diagnosed in a
timely fashion in these patients to ensure an early adaptation of drug regimes that minimise risk.
BTS Guidelines for the prevention and management of Mycobacterium tuberculosis infection and
disease in adult patients with chronic kidney disease were published in 2010. This national survey
was carried out to assess awareness of TB in CKD patients and its management.
Methods: To assess and understand the nationwide burden and awareness of TB in renal
impairment, we designed a survey was using the web based resource, Survey Monkey and
disseminated to all the renal units in the UK. This was designed to query the incidence of TB in
patients in renal units across the United Kingdom and subsequent adherence to guidelines related to
the same. The questions in the survey were designed to assess incidence of TB in CKD patients, any
potential bias in population groups, the frequency of screening and whether anti-TB therapy was
offered in the clinic.
Results: A total of 38 responses were received from renal dialysis units from England, Scotland and
NI. Of these, 40% also offered renal transplant to patients. A vast majority of the centres (92%)
reported a low incidence (<5%) of TB in CKD patients over a period on one year. However,
surprisingly the majority of centres (95%) did not routinely screen CKD patients for latent TB. Many
(71%) also did not screen for TB in patients with specific conditions (CKD4 and 5 and transplant
patients). The country of birth (endemic TB areas) played an important role in screening decisions
for some units-37% of units considered this as a driver for screening, however only 3% of the
respondents considered screening in people with social risks. A vast majority then referred the cases
to a local TB service (95%), however a similar number (91%) were also unaware for the transmission
of TB within their units.
Conclusions: Latent TB screening was carried out infrequently across the renal units in the country.
However screening did occur in patients with CKD 4 and 5 who were born outside UK. While, there
is a national guidance for treatment of TB in patients with chronic renal failure, its implementation
is not robust due to poor awareness. Most units correctly referred patient to local TB services.