The association between chronic kidney disease and tuberculosis; a comparative cohort study in England
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RESEARCH ARTICLE
Open Access
The association between chronic kidney disease and tuberculosis; a comparative cohort study in England Judith Ruzangi1, Masao Iwagami1,2* , Liam Smeeth1, Punam Mangtani3 and Dorothea Nitsch1
Abstract Background: People with end-stage kidney disease have an increased risk of active tuberculosis (TB). Previous systematic reviews have demonstrated that patients with chronic kidney disease (CKD) have increased risk of severe community-acquired infections. We investigated the association between CKD (prior to renal replacement therapy) and incidence of TB in UK General Practice. Methods: Using the UK Clinical Practice Research Datalink, 242,349 patients with CKD (stages 3-5) (estimated glomerular filtration rate < 60 mL/min/1.73 m2 for ≥3 months) between April 2004 and March 2014 were identified and individually matched (by age, gender, general practice and calendar time) to a control from the general population without known CKD. The association between CKD (overall and by stage) and incident TB was investigated using a Poisson regression analysis adjusted for age, gender, ethnicity, socio-economic status, chronic obstructive pulmonary disease (COPD) and diabetes. Results: The incidence of TB was higher amongst patients with CKD compared to those without CKD: 14.63 and 9.89 cases per 100,000 person-years. After adjusting for age, gender, ethnicity, socio-economic status, diabetes and COPD, the association between CKD and TB remained (adjusted rate ratio [RR] 1.42, 95% confidence interval [CI] 1.01–1.85). The association may be stronger amongst those from non-white ethnic minorities (adjusted RR 2.83, 95%CI 1.32–6.03, p-value for interaction with ethnicity = 0.061). Amongst those with CKD stages 3–5, there was no evidence of a trend with CKD severity. Conclusions: CKD is associated with an increased risk of TB diagnosis in a UK General Practice cohort. This group of patients should be considered for testing and treating for latent TB. Keywords: Tuberculosis, Chronic kidney disease, Epidemiology, Primary care, CPRD
Background Chronic kidney disease (CKD) is recognised as a growing public health problem [1]. CKD stages 3–5 (defined as estimated glomerular filtration rate [eGFR] < 60 mL/ min/1.73 m2 for ≥3 months) are estimated to affect approximately 6% of the general population in England [2]. CKD can progress to end-stage kidney disease (ESKD) * Correspondence: [email protected] 1 Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK 2 Department of Health Services Research, Faculty of Medicine, University of Tsukuba, building #861, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan Full list of author information is available at the end of the article
requiring renal replacement therapy (RRT) in a small but substantial proportion of people [3]. CKD is associated with a range of comorbidities and increased risk of infection and is classed as an independent risk factor for active tuberculosis (TB) [3–6]. Tuberculosis (TB) disease is
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