Tuberculosis (TB) remains a serious threat for some individuals and public health. Dialysis patients are particularly susceptible to this type of infection with their rate of active TB estimated to be 25 times higher than the general population. TB is caused by a slow-growing bacterium called Mycobacterium tuberculosis that usually lives in the lungs. It can spread from person to person, and in some cases be deadly if untreated.
As the first of its kind in Canada, a screening program piloted by BC Renal in partnership with the BC Centre for Disease Control (BCCDC) has proven effective at identifying and treating dialysis patients with latent TB infection (LTBI). The results are described in a study published in the American Journal of Kidney Disease
this past May.
Dr. Victoria Cook, medical head of Provincial Tuberculosis Services at the BCCDC, was involved in the study. She notes that if untreated, LTBI can lead to active TB, which can result in serious and widespread consequences: “In addition to risks for the individual patient, the public health consequences of an infectious TB case in a congregate setting such as a dialysis unit is significant.”
This pressing issue prompted BC Renal and the BCCDC to team up in 2012 and pilot a novel screening program, where dialysis patients were systematically screened and treated for LTBI when appropriate. The study involved 365 patients from across BC, whose LTBI treatment outcomes were compared before and after rollout of the screening program.
“We found that the vast majority – more than 80 percent – of people successfully completed LTBI therapy,” says Cook. What’s more, adverse events were most often associated with medication change rather than stopping LTBI treatment, showing that the screening program is generally safe for patients with appropriate monitoring.
Importantly, Cook notes that the screening process is fairly straightforward and is easily implemented into the clinical setting. It involves a TB risk assessment, blood test, and chest radiograph. Taken together these steps can reduce the chances of an active TB case in the dialysis unit, and may help to keep patients healthy if they go on to have a kidney transplant.
Cook says that the results from this study are continuing to inform medical practices across BC: “This program continues to function, and lessons learned have helped to guide decision-making around screening and treatment in other at-risk populations, such as solid organ transplant.”