Tuberculosis in patients undergoing maintenance hemodialysis therapy presents a number of diagnostic and therapeutic challenges. This study was designed to assess the specific diagnostic and therapeutic features of dialysis-associated tuberculosis in a clinical setting. A total of 55 patients were enrolled in this retrospective study over the 5-year period from 1996 to 2000. Diagnostic techniques included questionnaire, clinical examination, chest X- ray, tuberculin skin test, Mycobacterium tuberculosis (MT) screening on biological fluids and tissue biopsy. Tuberculosis was diagnosed in 6 patients (11%). The disease occurred within the first two years after the beginning of hemodialysis. Initial signs were nonspecific, i.e., fever, weight loss, and cough. Tuberculin skin testing was negative in 5 cases. Tuberculosis was located in the lung in 2 cases, pleura in 2 cases, peritoneum in 1, and lymph node in 1. Isolation of the MT and confirmation by tissue biopsy was performed in only one case. Appropriate polychemotherapy was successful in 5 of 6 cases. Morbidity and mortality of tuberculosis in dialysis patients is closely related to early detection and treatment. Therapy is often based on strong presumptive evidence without definitive diagnosis.
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