The outcome of tuberculosis in patients on chronic hemodialysis

Aim: In patients on regular hemodialysis, the incidence of tuberculosis is high. Material: We present 18 (6.08%) tuberculosis patients among 296 patie nts on regular hemodialysis between 1980 and 1996. Results: Pulmonary tuber culosis was seen in 11 (61%) patients, 7 (38%) of whom presented with pleur al effusion. Tuberculosis was extrapulmonary in 7 (38%) patients. There wer e 4 (22.2%) patients with tuberculous lymphadenitis, 2 (11.1%)with tubercul ous peritonitis, 1 (5.5%) with urinary tuberculosis. Intermittent fever, ma lasia and dyspnea were the most common symptoms. The mean duration on hemod ialysis before diagnosis of tuberculosis were 22.22 +/- 7.19 months and the mean duration of symptoms symptoms prior to treatment were 34.16 +/- 3.36 days. Tuberculosis was diagnosed in 10 (55.5%) patients within the first 4 months of dialysis and in 8 (34.4%) between the Ist and the 8th year of hem odialysis treatment. Our patients were treated with isoniazid, rifampicin, morfazinamid and ethambutol. Four patients died within the first 4 months o f the antituberculosis therapy, in all of whom tuberculosis was diagnosed w ithin the 4 months of dialysis, In patients who died, duration of symptoms ranged from 30 days to 60 days, mean 42 days. Overall mortality was 22.2% a nd correlated with the duration of symptoms prior to initiation of antitube rculosis and hemodialysis therapy. Fourteen patients (77.7%) who survived l onger than one year were clinically cured, Conclusion: Our results suggest that the mortality of tuberculosis is high in patients in the early phase o f maintenance dialysis and delay in the disease treatment of tuberculosis. Because of their generally poor state of nutrition, and depressed cellular immunity, the mortality is high in patients in the early stage of maintenan ce hemodialysis. Therefore, if the diagnosis is delayed, mortality is highe r. Tuberculosis should be considered strongly and treated promptly if suspe cted.