PULMONARY TUBERCULOSIS IN CHRONIC KIDNEY DISEASE PATIENTS ON MAINTENANCE HAEMODIALYSIS- A TERTIARY CARE CENTRE'S EXPERIENCE

BACKGROUND Patients of chronic kidney disease on maintenance haemodialysis are many fold prone to manifest active tuberculosis when compared to the general population. Not only is the timely diagnosis, but also the therapy of tuberculosis can be challenging in these patients in view of the meticulous dose adjustments. MATERIALS AND METHODS This retrospective study was undertaken with an aim of studying the clinical profile, laboratory characteristics, treatment tolerance and the course of pulmonary tuberculosis in patients of CKD on dialysis. Medical records of chronic kidney disease patients on maintenance haemodialysis for a period ranging from April 2013 to March 2017 were analysed. The diagnosis of Pulmonary Tuberculosis was based on the combination of various tools viz. Sputum microbiology, Nucleic acid testing, Pleural fluid analysis and/or by Radiologic findings. RESULTS A total of forty patients of pulmonary tuberculosis were identified. There was a male preponderance with a male-to-female ratio of 2:1. The most common native kidney disease was chronic glomerulonephritis and the most common risk factor evident was diabetes. Sixty five percent of patients had dialysis vintage ranging from 1-3 years. On tuberculin skin testing, only 45% of patients had induration of more than 10 mm. All patients received anti-tuberculous therapy at renally modified doses for a total period of 6-9 months and all patients tolerated the therapy well with only one patient experiencing optic neuritis and four patients developing arthralgias. No mortality was recorded in these patients during the study period. CONCLUSION Clinicians need to exercise high index of suspicion to diagnose Tuberculosis in CKD patients. Anti-tuberculous therapy is usually well tolerated in CKD patients, but mandate meticulous dose adjustments.