Evaluation of clinical profile, laboratory characteristics, and outcome of tuberculosis cases in a hemodialysis center in southeast Turkey

Patients with chronic renal failure (CRF) requiring dialysis are at an increased risk of developing tuberculosis (TB) when compared with the total population. In dialysis patients, the tuberculin skin test (TST) is not helpful diagnostically; this may be due to an overwhelming infection impairing the immune response. The purpose of this study was to evaluate the clinical profile, laboratory characteristics, and outcome of TB in patients with CRF undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Since February 1999, we have diagnosed only 8 active TB patients (5.4%) among a total 149 dialysis patients in our dialysis programs (HD or CAPD). Five patients developed pulmonary TB (including 2 with tuberculous pleurisy), 1 had cavitary TB, and 2 had miliary TB. Three of those patients developed extrapulmonary TB (1 had synovial and bone TB in the knee, and 2 had tuberculous lymphadenitis). All 8 patients who developed TB after starting dialysis had low creatinine clearances and, in general, hypoalbuminemia. We conclude that the appearance of miliary infiltrates or cavitary or pleural effusion on chest x-ray associated with fever in a dialysis patient strongly suggests TB. Therefore, the absence of acid-fast bacilli in investigated materials and negativity of the TST does not exclude TB in patients with CRF.