Progression of chronic kidney disease and the risk of tuberculosis: an observational cohort study

BACKGROUND: Little is known about tuberculosis (TB) risk in the earlier stages of chronic kidney disease (CKD). OBJECTIVE: To investigate the relationship between CKD at all stages and the risk of incident TB. METHODS: We conducted a cohort study using 100 058 participants of a community-based health screening programme in northern Taiwan, 2005-2008. Renal function was ascertained at baseline using serum creatinine level and the urine dipstick test. The occurrence of active TB was ascertained using the National Tuberculosis Registry. Cox proportional hazards regression was used to estimate the association between CKD and TB. RESULTS: During a median follow-up of 7.5 years, TB incidence was 472. In the Cox regression analyses, individuals with Stage 1-4 CKD had a 25% increase in TB hazard than those without disease (adjusted hazard ratio [aHR] 1.25, 95% CI 1.02-1.54). A positive correlation between CKD stage and TB was observed (P = 0.02 for trend). TB risk increased by 5.1% with every 10 ml/min/1.73 m(2) decrease in the estimated glomerular filtration rate (aHR 1.05, 95% CI 0.99-1.12). CONCLUSIONS: Our results suggested an increased risk of TB in early-stage CKD. TB prevention efforts should consider individuals with earlier stages of CKD.