Association of CKD with Incident Tuberculosis

Abstract

Background and objectives The incidence and risk of Mycobacterium tuberculosis in people with predialysis CKD has rarely been studied, although CKD prevalence is increasing in certain countries where Mycobacterium tuberculosis is endemic. We aimed to investigate the association between predialysis CKD and active Mycobacterium tuberculosis risks in a nation with moderate Mycobacterium tuberculosis risk.

Design, setting, participants, & measurements In this nationwide retrospective cohort study, we reviewed the National Health Insurance Database of Korea, screening 17,020,339 people who received a national health screeningtwo ormore times from2012 to 2016.PredialysisCKDwas identifiedwithconsecutive laboratory results indicative of CKD(e.g., persistent eGFR,60 ml/min per 1.73m2 ordipstick albuminuria). Peoplewith preexisting active Mycobacterium tuberculosis or kidney replacement therapy were excluded. A 1:1 matched control group without CKD was included with matching for age, sex, low-income status, and smoking history. The risk of incident activeMycobacteriumtuberculosis, identified inthe claimsdatabase,was assessed by themultivariableCox regression model, which included both matched and unmatched variables (e.g., body mass index, diabetes, hypertension, places of residence, and other comorbidities).

Results We included 408,873 people with predialysis CKD and the same number of controls. We identified 1704 patients with active Mycobacterium tuberculosis (incidence rate =137.5/100,000 person-years) in the predialysis CKDgroup and 1518 patients with activeMycobacteriumtuberculosis (incidence rate =121.9/100,000 person-years) in thematched controls. The activeMycobacterium tuberculosis riskwas significantly higher in the predialysis CKD group (adjusted hazard ratio, 1.21; 95%confidence interval, 1.13 to 1.30). The risk factors for active Mycobacterium tuberculosis among the predialysis CKD group were old age, men, current smoking, low income, underlying diabetes, chronic obstructive pulmonary disease, and Kidney Disease Improving Global Outcomes CKD stage 1 (eGFR$90 ml/min per 1.73m2with persistent albuminuria) or stage 4/5without dialysis (eGFR,30 ml/min per 1.73 m2).

Conclusions IntheKorean population, the incidence of activeMycobacteriumtuberculosiswas higher in peoplewith versus without predialysis CKD.