Tuberculosis incidence in patients with chronic kidney disease: a systematic review and meta-analysis

Ayinalem Alemu; Zebenay Workneh Bitew; Getu Diriba; Getachew Seid; Kirubel Eshetu; Musse Tadesse Chekol; Nega Berhe; Balako Gumi

doi:10.1016/j.ijid.2022.05.046

Tuberculosis incidence in patients with chronic kidney disease: a systematic review and meta-analysis

Int J Infect Dis. 2022 Sep:122:188-201. doi: 10.1016/j.ijid.2022.05.046. Epub 2022 May 21.

Authors

Ayinalem Alemu¹, Zebenay Workneh Bitew², Getu Diriba³, Getachew Seid⁴, Kirubel Eshetu⁵, Musse Tadesse Chekol⁴, Nega Berhe⁶, Balako Gumi⁶

Affiliations

¹ Ethiopian Public Health Institute, Addis Ababa, Ethiopia.; Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.. Electronic address: ayinalemal@gmail.com.
² St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
³ Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
⁴ Ethiopian Public Health Institute, Addis Ababa, Ethiopia.; Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
⁵ USAID Eliminate TB Project, Management Sciences for Health, Addis Ababa, Ethiopia.
⁶ Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.

PMID: 35609860
DOI: 10.1016/j.ijid.2022.05.046

Abstract

Objective: The aim of this study was to estimate global TB incidence in patients with CKD.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was followed to perform the study. Electronic and gray literature sources were investigated for studies published between 2000 and 2021. The Joanna Briggs Institute critical appraisal checklist was used to assess the quality of the studies, and STATA version 16 was used for analysis. The I² heterogeneity test was employed to assess heterogeneity. To examine publication bias, funnel plots and Egger's regression tests were performed.

Results: A total of 104 studies with a sample size of 1,548,774 were included. TB incidence in patients with CKD ranges from 60 per 100,000 in the UK to 19,270 per 100,000 in China. The pooled TB incidence was estimated as 3718 per 100,000 (95%CI; 3024, 4411). Higher pooled TB incidence was found in the African region (9952/100,000, 95%CI; 6854, 13,051), followed by the South-East Asian (7200/100,000, 95%CI; 4537, 9863) and Eastern Mediterranean (5508/100,000, 95%CI; 3470, 7547) regions. In particular, patients on hemodialysis (5611/100,000) and on peritoneal dialysis (3533/100,000) had higher incidence of TB than did renal transplantation patients (2700/100,000) and patients with predialysis CKD (913/100,000). Furthermore, extrapulmonary TB (2227/100,000) was more common than pulmonary TB (1786/100,000).

Conclusion: This study identifies high TB incidence in patients with CKD with regional disparities. Thus, the authors recommend active TB screening in this group of individuals.

Keywords: Chronic Kidney Disease; Incidence; Tuberculosis.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Humans
Incidence
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / epidemiology
Sample Size
Tuberculosis* / complications
Tuberculosis* / epidemiology
Tuberculosis, Pulmonary*