Prognosis of patients diagnosed with latent tuberculosis infection at dialysis initiation.

BACKGROUND: The prognosis of Japanese dialysis patients diagnosed with latent tuberculosis infection (LTBI) at the time of starting dialysis remains unclear. The purpose of this study was to examine whether there is a difference in prognosis between incident dialysis patients with and without LTBI.

METHODS: A retrospective study of incident dialysis patients who underwent an interferon-gamma release assay (T-SPOT test) within 1 year before or after dialysis initiation at our hospital between May 1, 2013, and December 31, 2021 was conducted. Using propensity score matching (PSM), survival of the non-LTBI and LTBI groups was compared after adjusting for patient background characteristics.

RESULTS: Of the 737 incident dialysis patients, 276 (37.4%) underwent the T-SPOT test, of whom 23 (8.3%) were diagnosed with LTBI. After matching for age, sex, activities of daily living (ADL), estimated glomerular filtration rate (eGFR), Charlson comorbidity index (CCI), and serum albumin level, 23 patients were selected for each group. Kaplan-Meier analysis showed a significantly lower cumulative survival rate in the LTBI group (p = 0.048, log-rank test). In the LTBI group, the cumulative survival rate tended to be higher in the LTBI-treated group (n = 13) than in the untreated group (n = 10) (p = 0.089).

CONCLUSION: Patients with LTBI at dialysis initiation have a poorer prognosis than those without LTBI, and LTBI treatment may improve their prognosis. This study emphasizes the clinical importance and necessity of managing LTBI in dialysis patients.