Risk of active tuberculosis in chronic kidney disease: a systematic review and meta-analysis.

BACKGROUND: Although the global prevalence of chronic kidney disease (CKD) is increasing, the relationship between CKD and active TB is not well described.

OBJECTIVE: To conduct a systematic review to evaluate active TB risk in CKD populations.

METHODS: We searched Ovid Medline, EMBASE and Cochrane databases and relevant journals to identify multicentre or regional studies reporting quantitative effect estimates of an association between CKD and active TB. Risk ratios and rate ratios were used as common measures of association. Pooled estimates were generated using a random-effects model.

RESULTS: Of 3406 papers screened, 12 eligible studies were identified with 71,374 end-stage renal disease (ESRD) patients and 560 TB cases. Meta-analysis of adjusted rate ratio data in dialysis populations showed an increased rate of 3.62 (95%CI 1.79-7.33, P < 0.001) compared to the general population, while unadjusted risk ratio data in transplant populations showed an increased risk of 11.35 (95%CI 2.97-43.41) compared to the general population.

CONCLUSION: We found consistent evidence of an increased risk of active TB in ESRD compared to the general population. This relationship persisted despite variability in study population, design and renal replacement therapy (RRT) modality. Further research into the role of comorbidities, RRT modality and CKD stage is required to better understand the association between CKD and active TB.