Risk of tuberculosis in dialysis patients: A nationwide cohort study

Claudia C. Dobler, Stephen P. McDonald, Guy B. Marks

Research output: Contribution to journalArticleResearchpeer-review

38 Citations (Scopus)

Abstract

Background: The ability to identify individuals at increased risk of developing tuberculosis (TB) has important implications for public health policy and patient care. We conducted a general population historical cohort study in all Australian States and Territories to establish the risk of TB arising in people on chronic hemo- or peritoneal dialysis. Methodology/Principal Findings: Cases of TB disease in patients receiving chronic dialysis were identified by record linkage using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and State and Territory TB notification databases 2001 to 2006. Main outcome measure was the relative risk of TB in people on dialysis, adjusted for TB incidence in country of birth, sex, age and indigenous status. A total of 6,276 cases of active TB were reported among 19,855,283 people living in Australia between 2001 and 2006. Among 14,506 patients on dialysis, 37 had a notification for TB disease after commencing dialysis, of whom 28 were culture positive. The incidence of TB was 66.8/100,000/year (95% CI 47.7 to 93.2) among people on dialysis and 5.7/100,000/year (95% CI 5.5 to 5.8) in the general population. The adjusted relative risk (aRR) of TB in people on dialysis was 7.8 (95% CI 3.3 to 18.7), and the aRR of culture positive TB was 8.6 (95% CI 3.9 to 19.3). Conclusions/Significance: Patients on dialysis are at increased risk of TB. The final decision to screen for, and to treat, LTBI in individual dialysis patients will be influenced by a cumulative assessment of the risk of reactivation of TB and by assessment of risk factors for adverse effects of treatment.

Original languageEnglish
Article numbere29563
JournalPLoS One
Volume6
Issue number12
DOIs
Publication statusPublished - 27 Dec 2011
Externally publishedYes

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Dialysis
dialysis
cohort studies
tuberculosis
Tuberculosis
Cohort Studies
relative risk
cumulative risk assessment
Transplants
Disease Notification
Public health
incidence
health policy
patient care
risk groups
public policy
Incidence
Peritoneal Dialysis
Public Policy
Health Policy

Cite this

Dobler, Claudia C. ; McDonald, Stephen P. ; Marks, Guy B. / Risk of tuberculosis in dialysis patients : A nationwide cohort study. In: PLoS One. 2011 ; Vol. 6, No. 12.
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Risk of tuberculosis in dialysis patients : A nationwide cohort study. / Dobler, Claudia C.; McDonald, Stephen P.; Marks, Guy B.

In: PLoS One, Vol. 6, No. 12, e29563, 27.12.2011.

Research output: Contribution to journalArticleResearchpeer-review

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