Interferon-Gamma Release Assay Combined with Renal Indicators to Reduce the False-Negativity of Latent Tuberculosis Infection in End-Stage Renal Disease with Hemodialysis Patients

Discov Med. 2024 May;36(184):1002-1011. doi: 10.24976/Discov.Med.202436184.93.

Abstract

Background: Tuberculosis (TB) is still the main cause of mortality due to a single transfectant, Mycobacterium tuberculosis (MTB). Latent tuberculosis infection (LTBI) is a condition characterized by the presence of tuberculosis (TB) that is not clinically apparent but nonetheless shows a sustained response to MTB. Presently, tuberculin skin test (TST) and interferon gamma (IFN-γ) release assays (IGRAs) are mainly used to detect LTBI via cell-mediated immunity of T-cells. For people with end-stage renal disease (ESRD), the diagnosis of patients infected with MTB is difficult because of T-cell dysfunction. To get more accurate diagnosis results of LTBI, it must compensate for the deficiency of IGRA tests.

Methods: Sixty-seven hemodialysis (HD) patients and 96 non-HD patients were enrolled in this study and the study population is continuously included. IFN-γ levels were measured by the QuantiFERON-TB Gold In-Tube (QFT-GIT) test. Kidney function indicators, blood urea nitrogen (BUN), serum creatinine (Cr), and estimated glomerular filtration rate (eGFR) were used to compensate for the declined IFN-γ levels in the IGRA test.

Results: In individuals who were previously undetected, the results of compensation with serum Cr increased by 10.81%, allowing for about 28% more detection, and compensation with eGFR increased by 5.41%, allowing for approximately 14% more detectable potential among them and employing both of them could enhance the prior shortcomings of IGRA tests. when both are used, the maximum compensation results show a sensitivity increase rate of 8.81%, and approximately 23% of patients who were previously undetectable may be found.

Conclusion: Therefore, the renal function markers which are routine tests for HD patients to compensate for the deficiency of IGRA tests could increase the accuracy of LTBI diagnosis.

Keywords: Mycobacterium tuberculosis (MTB); blood urea nitrogen (BUN); estimated glomerular filtration rate (eGFR); hemodialysis (HD); latent tuberculosis infection (LTBI); serum creatinine (Cr).

MeSH terms

  • Adult
  • Aged
  • Blood Urea Nitrogen
  • Creatinine / blood
  • False Negative Reactions
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Interferon-gamma / blood
  • Interferon-gamma Release Tests* / methods
  • Kidney Failure, Chronic* / blood
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / immunology
  • Kidney Failure, Chronic* / therapy
  • Latent Tuberculosis* / blood
  • Latent Tuberculosis* / diagnosis
  • Latent Tuberculosis* / immunology
  • Male
  • Middle Aged
  • Mycobacterium tuberculosis / immunology
  • Renal Dialysis* / adverse effects
  • Tuberculin Test / methods

Substances

  • Interferon-gamma
  • Creatinine