Tuberculosis screening practices and outcomes in an australian dialysis unit

BMC Nephrology

Research

Hannah Wallace¹  Sandra Crikis¹  Craig Nelson² 

[1] Department of Nephrology, Western Health, 176 Furlong Road St Albans, 3021, St Albans, VIC, Australia;Department of Nephrology, Western Health, 176 Furlong Road St Albans, 3021, St Albans, VIC, Australia;Department of Medicine, Western Health, University of Melbourne, 3021, Melbourne, VIC, Australia;Western Health Chronic Disease Alliance, Western Health, 3021, St Albans, VIC, Australia;Deakin University, Victoria, Australia;

关键词: Latent tuberculosis infection;    Dialysis;    Active tuberculosis;    Quantiferon Gold screening;   

DOI  :  10.1186/s12882-023-03304-0

 received in 2023-02-17, accepted in 2023-08-20,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe World Health Organisation (WHO) recommends all dialysis patients undertake routine screening for latent tuberculosis infection (LTBI) in high income countries such as Australia. However, we employ a targeted screening approach in our Australian dialysis unit in line with local and some international guidelines. We analysed our practices to assess the validity of our approach.MethodsA retrospective review of new dialysis patients during the period 2012–2018 was undertaken. Patient records were reviewed for basic demographic data, comorbidities, LTBI screening using Quantiferon Gold (QFG), and outcomes, including episodes of active TB, to June 2020.Results472 patients were included. WHO high risk country of origin patients accounted for 22% (n = 103). 229 patients (48.5%) were screened using QFG. The single main indication for screening was transplantation waitlisting. 34 patients had a positive QFG result. Active tuberculosis developed in two patients during the observation period. Both occurred in the screened cohort, the cases having previously tested negative via QFG at 11 and 16 months, prior to the development of active tuberculosis. No patients in the unscreened cohort developed active tuberculosis during the observation period. WHO high risk country of origin was associated with positive QFG status, odds ratio 10.4 (95% CI 3.3–31.2).ConclusionThe data failed to show a benefit from widening of the screening program within our dialysis unit. However, a much larger sample size will be required to confidently assess the impact of the current approach on patient outcomes. Analysis of current screening practices and outcomes across all Australian dialysis services is warranted to assess the risks and benefits of widening the screening practices to include all dialysis patients as recommended by the WHO.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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