Tuberculosis in Hemodialysis Patients in Area of High Incidence of Mycobacterium tuberculosis and Human Immunodeficiency Virus Infection

BACKGROUND Hemodialysis (HD) patients have an increased incidence of tuberculosis (TB), which may be due to decreased cellular immunity, the presence of malnutrition, and the use of immunosuppressive drugs. Poor living conditions, overcrowding, and human immunodeficiency virus (HIV) infection could be considered added risk factors. This study analyzed the incidence and clinical characteristics of TB among HD patients in an area where TB and HIV infection have a high prevalence. METHODS In this multicenter study, 1266 patients (663 men and 603 women) ages 20–91 years (46.1 ± 16.8 years) from 8 HD centers in different cities of Rio de Janeiro State, Brazil, were studied. HIV‐infected patients were excluded from the study. RESULTS TB was observed in 30 patients (2.3%), the pulmonary type in 11 (36.6%) and the extrapulmonary type in 19 (63.4%). The time of emergence during the HD period was very wide (2–117 months). All patients presented with unexplained fever and general symptoms such as weight loss, fatigue, and malaise in variable frequencies. The purified protein derivative (tuberculin) test was positive in only 16.6% of TB patients. They were treated with a combination of rifampicin (450–6000 mg/day), isoniazid (200–300 mg/day), and pyrazinamide (1.5–2 g/day); only 1 patient died, and 2 underwent a successful renal transplantation after the treatment. CONCLUSIONS TB incidence in HD patients was higher than in the general population (p