Ravi R. Pradhan
MD Internal Medicine resident Institute of Medicine (IOM), Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal
Title: Prevalence, clinical presentation and outcome of tuberculosis in patients with chronic kidney disease at a tertiary care hospital in Nepal
Biography
Biography: Ravi R. Pradhan
Abstract
A hospital-based cross-sectional study was performed by including patients older than 16 years with the diagnosis of CKD stage 3, 4, 5, and 5D (CKD 5 on maintenance dialysis). Diagnosis of tuberculosis was established by clinical, radiological and laboratory findings. Renal transplant recipient patients were excluded from the study. Prior written informed consent was obtained from the patients or their accompanying persons. Site of study was TUTH, a tertiary referral centre located in Kathmandu, Nepal.
Results:
A total of 401 patients with CKD were included in the study (mean age, 50.92 ±17.98 years; 64.8% male). The prevalence of TB in CKD patients was found to be 13.7% (55). Most common clinical presentations of TB in CKD were anorexia (85.7%), fever (83.7%), weight loss (51%), and cough (49%). Thirty eight patients (69.1 %) had extrapulmonary TB (EPTB), 12 (21.8%) had pulmonary TB, 3 (5.5%) had disseminated TB and 2 (3.6%) had miliary TB. Only 4.1% cases were smear positive. Pleural effusion (34.2%) was the most common EPTB. At 2 months of starting ATT, 29 patients out of the 49 newly diagnosed cases of TB (59.2%) had responded to therapy. The mortality at 2 months was 28.6% (14 had died amongst 49 patients). Four out of 49 patients (8.2%) didn’t improve, and 2 (4%) patients were lost to follow up. Mortality rate was relatively higher in miliary TB (one out of two patients died), and disseminated TB (one out of three patients died)
Conclusion :
Prevalence and mortality of TB was higher in cohort of CKD. Special attention must be given to these people for timely diagnosis and treatment as the presentation is different and diagnosis can be missed.