Korean J healthc assoc Infect Control Prev.  2021 Dec;26(2):96-100. 10.14192/kjicp.2021.26.2.96.

Predictive Value of Positive Interferon-Gamma Release Assay for Hemodialysis Patients: A Cross-Sectional Study in a Tertiary Care Hospital in South Korea

• Kim YN
• Lee J
• Jung Y

• KMID: 2523607
• DOI: http://doi.org/10.14192/kjicp.2021.26.2.96

Abstract

Background
Tuberculosis (TB) is a common infectious disease in dialysis patients with profound alterations in immune response. The risk of TB among dialysis patients is important but remains unclear. This study aimed to determine various factors associated with latent TB infection (LTBI) in patients undergoing hemodialysis (HD) in Korea.
Methods
This cross-sectional study was conducted in a tertiary care hospital in South Korea. HD patients were tested with interferon-gamma release assay (IGRA) and filled out a questionnaire for LTBI association factor assessment and analysis. The variables (age, sex, body mass index, smoking, previous contact with a person with active TB, dialysis duration, and hemoglobin and albumin levels) were included in a logistic regression model.
Results
Of the 82 participants enrolled, 45 (54.9%) in the dialysis group were IGRA-positive. Independent predictors of LTBI in patients undergoing HD were age (50-59 years), smoking habit, history of contact with an active TB case, and duration of HD (≥60 months) using multi-variate logistic regression.
Conclusion
The prevalence of positive IGRA was >50% among HD patients in a tertiary care hospital in South Korea. Therefore, routine screening tests for LTBI with IGRA in HD in Korea are recommended, especially for patients aged 50-59 years, those who smoke, and those with a history of contact with an active tuberculosis case and long duration of HD (>60 months).

Keyword

Tuberculosis; Infection; Hemodialysis; Interferon-gamma release assay; Prevalence

Reference

1. Min J, Kim JS. 2019; Diagnosis and treatment of latent tuberculosis infection. J Korean Med Assoc. 62:11–7. DOI: 10.1097/QCO.0000000000000629,. PMID: 32022744.

2. Lee SH. 2018; Diagnosis and treatment of latent tuberculosis infection: the updated 2017 Korean guidelines. Korean J Med. 93:509–17. DOI: 10.3904/kjm.2018.93.6.509.

3. Horsburgh CR Jr. 2004; Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med. 350:2060–7. DOI: 10.1056/NEJMsa031667. PMID: 15141044.

4. Li SY, Chen TJ, Chung KW, Tsai LW, Yang WC, Chen JY, et al. 2011; Mycobacterium tuberculosis infection of end-stage renal disease patients in Taiwan: a nationwide longitudinal study. Clin Microbiol Infect. 17:1646–52. DOI: 10.1111/j.1469-0691.2011.03473.x. PMID: 21375664.

5. Dobler CC, McDonald SP, Marks GB. 2011; Risk of tuberculosis in dialysis patients: a nationwide cohort study. PLoS One. 6:e29563. DOI: 10.1371/journal.pone.0029563. PMID: 22216316. PMCID: PMC3246480.

6. Lee SS, Chou KJ, Dou HY, Huang TS, Ni YY, Fang HC, et al. 2010; High prevalence of latent tuberculosis infection in dialysis patients using the interferon-gamma release assay and tuberculin skin test. Clin J Am Soc Nephrol. 5:1451–7. DOI: 10.2215/CJN.01790210. PMID: 20538837. PMCID: PMC2924420.

7. Shu CC, Wu VC, Yang FJ, Pan SC, Lai TS, Wang JY, et al. 2012; Predictors and prevalence of latent tuberculosis infection in patients receiving long-term hemodialysis and peritoneal dialysis. PLoS One. 7:e42592. DOI: 10.1371/journal.pone.0042592. PMID: 22916137. PMCID: PMC3423405.

8. Triverio PA, Bridevaux PO, Roux-Lombard P, Niksic L, Rochat T, Martin PY, et al. 2009; Interferon-gamma release assays versus tuberculin skin testing for detection of latent tuberculosis in chronic haemodialysis patients. Nephrol Dial Transplant. 24:1952–6. DOI: 10.1093/ndt/gfn748. PMID: 19164327.

9. Go U, Park M, Kim UN, Lee S, Han S, Lee J, et al. 2018; Tuberculosis prevention and care in Korea: evolution of policy and practice. J Clin Tuberc Other Mycobact Dis. 11:28–36. DOI: 10.1016/j.jctube.2018.04.006. PMID: 31720389. PMCID: PMC6830170.

10. Kim HW, Kim JS. 2018; Treatment of latent tuberculosis infection and its clinical efficacy. Tuberc Respir Dis (Seoul). 81:6–12. DOI: 10.4046/trd.2017.0052. PMID: 29332319. PMCID: PMC5771748.

11. Palomar R, Arias Guillén M, Robledo C, Agüero R, Agüero J, Rodríguez C, et al. 2011; [Detection of latent tuberculosis infection in peritoneal dialysis patients: new methods]. Nefrologia. 31:169–73. Spanish. DOI: 10.3265/Nefrologia.pre2011.Jan.10765. PMID: 21461010.

12. Shu CC, Hsu CL, Lee CY, Wang JY, Wu VC, Yang FJ, et al. 2015; Comparison of the prevalence of latent tuberculosis infection among non-dialysis patients with severe chronic kidney disease, patients receiving dialysis, and the dialysis-unit staff: a cross-sectional study. PLoS One. 10:e0124104. DOI: 10.1371/journal.pone.0124104. PMID: 25919813. PMCID: PMC4412816.

13. Brij SO, Beck SC, Kleemann F, Jack AL, Wilkinson C, Enoch DA. 2014; Tuberculosis screening in a dialysis unit: detecting latent tuberculosis infection is only half the problem. J Hosp Infect. 87:241–4. DOI: 10.1016/j.jhin.2014.05.008. PMID: 25027226.

14. Park JS. 2018; The prevalence and risk factors of latent tuberculosis infection among health care workers working in a tertiary hospital in South Korea. Tuberc Respir Dis (Seoul). 81:274–80. DOI: 10.4046/trd.2018.0020. PMID: 30238715. PMCID: PMC6148103.

15. Yeon JH, Seong H, Hur H, Park Y, Kim YA, Park YS, et al. 2018; Prevalence and risk factors of latent tuberculosis among Korean healthcare workers using whole-blood interferon-γ release assay. Sci Rep. 8:10113. DOI: 10.1038/s41598-018-28430-w. PMID: 29973678. PMCID: PMC6031657.

16. Christopoulos AI, Diamantopoulos AA, Dimopoulos PA, Goumenos DS, Barbalias GA. 2009; Risk factors for tuberculosis in dialysis patients: a prospective multi-center clinical trial. BMC Nephrol. 10:36. DOI: 10.1186/1471-2369-10-36. PMID: 19895701. PMCID: PMC2779182.

17. Shu CC, Hsu CL, Lee CY, Wu VC, Yang FJ, Wang JY, et al. 2016; Inflammatory markers and clinical characteristics for predicting persistent positivity of interferon gamma release assay in dialysis population. Sci Rep. 6:34577. DOI: 10.1038/srep34577. PMID: 27703202. PMCID: PMC5050411.

18. Christopoulos AI, Diamantopoulos AA, Dimopoulos PA, Gumenos DS, Barbalias GA. 2006; Risk of tuberculosis in dialysis patients: association of tuberculin and 2,4-dinitrochlorobenzene reactivity with risk of tuberculosis. Int Urol Nephrol. 38:745–51. DOI: 10.1007/s11255-006-9051-3. PMID: 17216297.

19. Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. 2007; Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health. 7:234. DOI: 10.1186/1471-2458-7-234. PMID: 17822539. PMCID: PMC2001194.