To the Editor.
—Several recent reports have brought attention to the problem of tuberculosis (TB) in patients with chronic renal failure (CRF).1-4 They suggest that the incidence of active TB is increased in maintenance hemodialysis patients,1-3 as well as in patients with less severe renal insufficiency.4 Of particular note is the frequency of extrapulmonary and difficult-to-diagnose cases reported and the fact that many of the patients had anergy to skin tests.Increased susceptibility to mycobacterial disease is not surprising in view of the defects in cell-mediated immunity that have been demonstrated in dialysis patients.5 As part of routine surveillance, our patients have PPD skin tests every six months. Our present population of in-center and home peritoneal and hemodialysis patients shows an 18% incidence (19/ 107) of positive PPD reactivity. Of these 19, pulmonary TB developed in three after beginning dialysis. In one of these patients, recurrent
Brandspigel K, Mattern WD. Tuberculosis in Chronic Renal Failure. Arch Intern Med. 1980;140(12):1674-1675. doi:10.1001/archinte.1980.00330230120031