Journal of Korean Medical Science

Korean Acad Medical Sciences (대한의학회)
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End-stage Renal Disease and Risk of Active Tuberculosis: a Nationwide Population-Based Cohort Study

  • Min, Jinsoo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Soon Kil (Department of Internal Medicine, Chungbuk National University College of Medicine) ;
  • Jeong, Hye Won (Department of Internal Medicine, Chungbuk National University College of Medicine) ;
  • Han, Joung-Ho (Department of Internal Medicine, Chungbuk National University College of Medicine) ;
  • Kim, Yeonkook Joseph (Graduate School of Health Science Business Convergence, Chungbuk National University College of Medicine) ;
  • Kang, Minseok (Department of Health Information and Management, Chungbuk National University College of Medicine) ;
  • Kang, Gilwon (Department of Health Information and Management, Chungbuk National University College of Medicine)
  • Received : 2018.07.25
  • Accepted : 2018.10.09
  • Published : 2018.12.31
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Abstract

Background: The converging epidemics of tuberculosis (TB) and end-stage renal disease (ESRD) have generated a significant public health burden, however, previous studies have been limited to a small number of patients. This nationwide cohort study aimed to assess the rate of developing active 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 propensity score matched to an equivalent number of non-dialysis subjects from the general population. The incidences of active TB in the ESRD and control cohorts were calculated for 2004-2013, and multivariable Cox proportional hazards model was used to evaluate the ESRD-related risk of active TB. Results: During 2004-2013, 59,584 patients received dialysis for newly diagnosed ESRD. In the dialysis and control cohorts, 457 (0.8%) and 125 (0.2%) cases of active TB were detected, respectively. Patients with ESRD were associated with a significantly higher risk of active TB compared to the controls (incidence rate ratio, 4.80). The ESRD cohort had an independently elevated risk of active TB (adjusted hazard ratio, 4.39; 95% confidence interval, 3.60-5.37). Conclusion: We found that patients receiving dialysis for ESRD had an elevated risk of active TB. These results highlight the need for detailed and well-organised guidelines for active TB screening among patients with ESRD.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea

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