Tuberculin Skin Test and Anergy in Dialysis Patients of Tuberculosis Endemic Area

Uremic patients are at an increased risk to get tuberculosis (TB) infection. Periodical Tuberculin skin tests, were suggested to find the newly infected TB patients. They were replaced by chest radiographies in endemic areas like Taiwan. However, almost half to TB in dialysis patients was extra-pulmonary. In this study we tried to investigate the value of tuberculin test in dialysis patients. Patients were recruited from our dialysis unit. PPD and control test with antigens for Candida and toxoid were placed using the Mantoux method. PPD with ＞ 10-mm induration will be considered positive. Skin anergy meant the indurations of all antigens were less than 5 mm. A follow-up was done 12 months after the test. In total 177 patients were evaluated. Anergy was found in 40 patients (22.6%). A positive predictor of anergy was ages ＞45 years (p=0.03), while negative predictors were lymphocyte ＞ 20% (p =0.04) and prealbumin ＞ 20 mg/dl (p=0.04). There were 53 (30%) patients had positive PPD test. Seven (13.2%) of 53 positive PPD patients developed active TB during the following one year. Among the 40 patients with skin anergy, six (15%) patients were found to have active TB. Of forty-eight (21.1%) patients with induration of PPD test between 5 – 11 mm, no patients were found to have active TB. In conclusion, although anergy will influence the sensitivity of PPD tests, PPD tests in combination with anergy tests could help the diagnosis of TB in uremic patients even in TB endemic areas.

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