The association between chronic kidney disease and tuberculosis; a comparative cohort study in England
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 betw...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Nephrology |
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| Online Access: | http://link.springer.com/article/10.1186/s12882-020-02065-4 |
| _version_ | 1811327046496813056 |
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| author | Judith Ruzangi Masao Iwagami Liam Smeeth Punam Mangtani Dorothea Nitsch |
| author_facet | Judith Ruzangi Masao Iwagami Liam Smeeth Punam Mangtani Dorothea Nitsch |
| author_sort | Judith Ruzangi |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-13T14:59:45Z |
| format | Article |
| id | doaj.art-1e15da3820c4441d8795fcfe8c428627 |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-04-13T14:59:45Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-1e15da3820c4441d8795fcfe8c4286272022-12-22T02:42:19ZengBMCBMC Nephrology1471-23692020-10-012111910.1186/s12882-020-02065-4The association between chronic kidney disease and tuberculosis; a comparative cohort study in EnglandJudith Ruzangi0Masao Iwagami1Liam Smeeth2Punam Mangtani3Dorothea Nitsch4Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical MedicineDepartment of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical MedicineAbstract 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.http://link.springer.com/article/10.1186/s12882-020-02065-4TuberculosisChronic kidney diseaseEpidemiologyPrimary careCPRD |
| spellingShingle | Judith Ruzangi Masao Iwagami Liam Smeeth Punam Mangtani Dorothea Nitsch The association between chronic kidney disease and tuberculosis; a comparative cohort study in England BMC Nephrology Tuberculosis Chronic kidney disease Epidemiology Primary care CPRD |
| title | The association between chronic kidney disease and tuberculosis; a comparative cohort study in England |
| title_full | The association between chronic kidney disease and tuberculosis; a comparative cohort study in England |
| title_fullStr | The association between chronic kidney disease and tuberculosis; a comparative cohort study in England |
| title_full_unstemmed | The association between chronic kidney disease and tuberculosis; a comparative cohort study in England |
| title_short | The association between chronic kidney disease and tuberculosis; a comparative cohort study in England |
| title_sort | association between chronic kidney disease and tuberculosis a comparative cohort study in england |
| topic | Tuberculosis Chronic kidney disease Epidemiology Primary care CPRD |
| url | http://link.springer.com/article/10.1186/s12882-020-02065-4 |
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