Tuberculosis incidence in patients with chronic kidney disease: a systematic review and meta-analysis.

Highlights

• Patients with chronic kidney disease (CKD) have high tuberculosis (TB) risk

• The global TB incidence in patients with CKD is estimated as 3718 per 100,000 patients with CKD

• The African, Southeast Asian, and Eastern Mediterranean regions have high TB incidence

• Among patients with CKD, patients on dialysis have a higher TB incidence

• In patients with CKD, extrapulmonary TB is more common than pulmonary TB

Abstract

Objective

The aim of this study was to estimate global TB incidence in patients with CKD.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was followed to perform the study. Electronic and gray literature sources were investigated for studies published between 2000 and 2021. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the studies, and STATA version 16 was used for analysis. The I² heterogeneity test was employed to assess heterogeneity. To examine publication bias, funnel plots and Egger's regression tests were performed.

Results

A total of 104 studies with a sample size of 1,548,774 were included. TB incidence in patients with CKD ranges from 60 per 100,000 in the UK to 19,270 per 100,000 in China. The pooled TB incidence was estimated as 3718 per 100,000 (95%CI; 3024, 4411). Higher pooled TB incidence was found in the African region (9952/100,000, 95%CI; 6854, 13,051), followed by the South-East Asian (7200/100,000, 95%CI; 4537, 9863) and Eastern Mediterranean (5508/100,000, 95%CI; 3470, 7547) regions. In particular, patients on hemodialysis (5611/100,000) and on peritoneal dialysis (3533/100,000) had higher incidence of TB than did renal transplantation patients (2700/100,000) and patients with predialysis CKD (913/100,000). Furthermore, extrapulmonary TB (2227/100,000) was more common than pulmonary TB (1786/100,000).

Conclusion

This study identifies high TB incidence in patients with CKD with regional disparities. Thus, the authors recommend active TB screening in this group of individuals.