Extrapulmonary tuberculosis in patients with chronic kidney disease receiving renal replacement therapy

<b>Aim:</b> To understand the clinical features of extra-pulmonary tuberculosis (TB) in patients with Chronic Kidney Disease (CKD) on Renal Replacement Therapy (RRT). <b>Methods:</b> Cases of active TB in patients with CKD requiring RRT between 2007 and 2017 were assessed using retrospective analysis of electronic records at a large London tertiary renal referral centre. <b>Results:</b> A of total of 50 patients were identified, 80% of whom had extra-pulmonary TB. The majority (65%) were of South Asian origin with an average age of 52.4 years. Diabetic and hypertensive nephropathy were the predominant causes of CKD. Modality of RRT at diagnosis of TB was: haemodialysis in 30 (75%), peritoneal dialysis in 5 (12.5%) and transplant in 3 (7.5%). Constitutional features such as fever, weight loss and night sweats were the main presenting feature (30%). The diagnosis was confirmed by TB culture in 22 (55%) patients, clinical/radiological features in 7 (17.5%) and through histology in 11(27.5%). The most common sites of disease were lymph node TB (57.5%) and peritoneal TB (25%). A large proportion of patients (45%) received standard TB therapy for 6 months, and completion rates were similar to the national average for all patients receiving TB treatment in the UK (80% cf 83.3%). Mortality was 7.5% which is higher than the national average of 5.3%. <b>Conclusion:</b> We identified a higher proportion of patients with extra-pulmonary TB in our population compared to the national figure of 58.0% in all patients diagnosed with TB. Despite co-morbidity of patients with CKD on RRT, the treatment completion rates and mortality of these patients were similar to national rates for all patients with active TB.