Low body mass index is associated with tuberculosis infection in patients starting continous ambulatory peritoneal dialysis
Abstract number: R2499
Lee H.S., Jeong S.J., Choi H., Jin B.S., Choi S.H., Han S.H., Kim M.S., Kim C.O., Choi J.Y., Song Y.G., Choe K.W., Kang M.W., Kim J.M.
Background; Due to lack of the cell-mediated immune response that is responsible for killing intracellular organisms in uremic individuals, there is an 8 to 25-fold increased risk of tuberculosis in patients on dialysis due to renal failure, compared to the general population. Because tuberculosis is well managed if detected early, it is important not only to make an early diagnosis based on clinical suspicion, but to suspect tuberculosis of patients who are highly susceptible to the disease. This study was undertaken to investigate the epidemiology and risk factors associated with tuberculosis infection in patients starting continous ambulatory peritoneal dialysis.
Method; A retrospective review of 203 patients who initiated peritoneal dialysis from January 2000 to December 2005 at Severance Hospital due to chronic renal failure was performed. Diagnosis of tuberculosis was made based on the following; 1) if AFB was positive on sputum, body fluid smear, tissue stain, cultures or 2) caseous necrosis was present on a tissue sample or 3) if x-ray findings strongly suggested tuberculosis lesions and lesions improved after anti-tuberculous medication. To determine risk factors for tuberculosis, we analysed gender, age, diabetes, serum albumin level, hemoglobulin level, body mass index(BMI), presence of heart failure, medication and etc. All the data including biochemical, weight and height were collected within a month of dialysis commencement.
Results; Among 203 patients enrolled, 18 patients were diagnosed with tuberculosis infection during the study period. The incidence was 28 per 1000 patient years. Upon univariate analysis, risk factors that seemed to be statistically significant for tuberculosis infection were reduced BMI, use of diuretics and the use of angiotensin receptor blockers. No other factors including diabetes mellitus, statin use, age, albumin, cholesterol level showed relevance. Logistic regression analysis revealed that low BMI (P < 0.001) was the significant predictor associated with the development of tuberculosis.
Conclusion; Our study revealed that low BMI at the start of dialysis is associated with tuberculosis. Since tuberculosis in chronic renal disease patients have potential progressive nature and dangerous outcome, we suggest that a more close observation made be needed for patients who have low BMI, initiating peritoneal dialysis.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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