Tuberculosis in hemodialysis: A diagnostic and therapeutic challenge.

Tuberculosis (TB) is a significant clinical and public health problem for patients with chronic kidney disease (CKD), particularly those requiring hemodialysis (HD). This population is particularly vulnerable due to the profound alteration of the immune response characteristic of CKD, which significantly increases the risk of reactivation of latent TB. The Mantoux test, for example, is not suitable for diagnosis due to the low sensitivity of these patients and the high rate of false positives due to vaccination. In contrast, IGRAs (interferon-gamma release assays) show superior sensitivity and specificity for diagnosing latent TB. Similarly, the high frequency of extrapulmonary manifestations of TB in dialysis patients must be taken into account, as this can lead to a delay in diagnosis and therefore favor nosocomial transmission. This is why it is essential to maintain a high level of clinical suspicion and make appropriate use of the available complementary tests in order to establish an early diagnosis and initiate targeted treatment to reduce morbidity and mortality. Regarding treatment in the general population, short, oral regimens are recommended for both drug-susceptible and drug-resistant TB in eligible individuals; however, there are no formal recommendations on the efficacy and/or safety of these regimens for the treatment of pulmonary tuberculosis in hemodialysis patients.