Tuberculose e doença renal crônica : aspectos epidemiológicos e clínicos da convergência de duas epidemias

Abstract

Chronic kidney disease (CKD) is consider a pandemic. Subjects with CKD have an impaired immunologic system and are more susceptible to infectious diseases including tuberculosis (TB) - another global public health problem. Thus, subjects with CKD have a higher risk to TB and there are evidences that they also have a poor treatment outcome. This study aims to investigate the epidemiological and clinical aspects of CKD and TB convergence. RESULTS: Through a systematic review and meta-analysis we found a pooled prevalence of TB in kidney transplant recipients of 2.51% (95% CI = 2.17 2.85). In Espírito Santo state this prevalence was 1.54% (95% CI 0.71% 2.38%) and was associated with: prior TB history (OR = 40.71; CI 95% 2.54 651.84), number of infectious episodes (OR = 1.35; CI 95% 1.10 1.67) and use of sirolimus as initial immunosuppressive drug (OR = 41.40; CI 95% 2.59 660.31). The median of years for TB development after the transplantation in the same sample was four years. Among thirteen subjects with TB, eight had pulmonary disease, seven needed hospitalization and four died due to TB. Regarding the factors that differentiate the chances of abandonment and death from cure among Brazilian subjects with CKD were: age, alcoholism, AIDS, jail, kidney transplantation, previous abandonment of treatment, ray-X suspicious for TB and directly observed therapy. CONCLUSION: The challenges shown by the relationship between TB and CKD, since a higher prevalence until a poor treatment outcome, are enormous and our data strengthen the need of strategies to control TB with priority subjects with chronic non communicable disease like CKD.