Active tuberculosis among patients with presumptive tuberculosis with chronic kidney disease in a high tuberculosis burden country, Ethiopia: a multi-center study

• Patients with chronic kidney disease (CKD) in Ethiopia has a high tuberculosis (TB) risk. • Patients on hemodialysis had higher TB risk compared to pre-dialysis patients. • Diabetes mellitus comorbidity in patients with CKD increases the risk of TB. • Systematic TB screening among patients with CKD is important. To assess tuberculosis (TB) and associated factors among patients with presumptive TB with chronic kidney disease (CKD). A prospective cross-sectional study was conducted from January to December 2023 among 381 patients with CKD attending six hospitals found in five regions of Ethiopia. Sputum and urine specimens were collected and examined for TB using smear microscopy, culture, and Xpert MTB/RIF Ultra assay. Data were analyzed using SPSS version 27. Descriptive statistics and logistic regression models were executed. More than half (206, 54.1%) were male, with a mean age of 45.08 years. A total of 94.0% (358) were pre-dialysis patients with CKD, and 90% (343) had additional comorbidity. TB was detected in 12.9% (49), with 10.5% (40) bacteriologically confirmed and 2.4% (9) clinically diagnosed TB. Previous or current cigarette smoking (adjusted odds ratio [aOR]; 2.82), decreased appetite (aOR; 5.97), night sweats (aOR; 2.21), diabetes comorbidity (aOR; 3.01), positive dipstick albuminuria (aOR; 5.55), less than 1-year follow-up in the renal unit (aOR; 9.49), body mass index <18.5 kg/m 2 (aOR; 6.69), and hemodialysis (aOR; 4.41) were all associated with TB. TB is a substantial cause of morbidity among patients with CKD in Ethiopia, necessitating programmatic intervention. Thus, active TB screening and surveillance among patients with CKD in Ethiopia is important.