Comparison of the QuantiFERON-TB Gold In-Tube test with the tuberculin skin test for detecting latent tuberculosis infection in hemodialysis patients.

BACKGROUND AND OBJECTIVES: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis (TB) infection (LTBI). LTBI screening of this population is recommended. The QuantiFERON-TB Gold assay (QFT-G) may be more accurate than the tuberculin skin test (TST) in the detection of LTBI. We prospectively compared the results of QFT-G to TST in HD patients. METHODS: We examined 100 patients and performed TST and QFT-G tests. Data obtained from patients and medical records included medical history (past history of TB, Bacillus Calmette-Guerin [BCG] vaccination, history of contact with previous TB cases), radiography reports (chest x-ray with changes consistent with old TB), and basic laboratory findings. RESULTS: Forty-three of 100 patients (43%) had a positive QFT-G test result and 34 (34%) had a positive TST test result. Overall agreement between the QFT-G and the TST was 65% (concordance [k]=0.26, P=0.01). Discordant test results were seen in 13 TST-positive/QFT-G-negative patients and in 22 TST-negative/QFT-G-positive patients. Before BCG vaccination and radiographic reports (of old TB changes) were associated with discordant test results. On multivariate analysis, a positive QFT-G test was associated with contact with previous TB cases (P=0.026) and radiographic report (P=0.034), whereas a positive TST test also was associated with a history of BCG vaccination (P=0.015). CONCLUSIONS: QFT-G test results were more closely associated with TB risk factors than were positive TST results. Additionally, the QFT-G test was not affected by BCG vaccination. We concluded that QFT-G test is a more useful diagnostic method than TST for detecting LTBI in HD patients.

Evaluation of periodontal parameters in patients undergoing peritoneal dialysis or hemodialysis.

OBJECTIVE: To analyze and compare periodontal parameters in chronic renal failure (CRF) patients undergoing peritoneal dialysis (PD) therapy with a group of patients on hemodialysis (HD) treatment and healthy controls (C). PARTICIPANTS: Seventy-five PD patients (mean age: 44 +/- 12 years) were matched with 41 HD patients (mean age: 46 +/- 15 years) and 61 C (mean age: 46 +/- 18 years). METHODS: Plaque (PI) and calculus (CSI) accumulation and gingival bleeding (GI) were recorded with the appropriate indices. Periodontal condition was assessed using the probing pocket depth (PPD). One-way anova test, Pearson chi-squared test, Mann-Whitney U-test and Kruskal-Wallis test were performed to compare PD patients with HD patients and healthy C. RESULTS: Plaque Index values were significantly higher (P < 0.001) in the PD and HD groups than the C group. GI values were significantly higher (P < 0.01) in the HD group than the PD group. Finally, CSI values in the PD and HD groups were also significantly higher (P < 0.001) than the C group. CONCLUSIONS: Chronic renal failure patients on PD treatment are more susceptible to periodontal diseases like HD patients. Thus, it is very important to maintain an optimal oral hygiene level. Further studies on periodontal parameters of only PD patients are needed to get more information on the oral health status of this patient group.

Dental and periodontal findings in hemodialysis patients.

OBJECTIVE: Oral health problems of chronic renal failure patients can compromise systemic health. This study compared the periodontal and dental health status of patients on hemodialysis (HD) with healthy controls (C). STUDY DESIGN: Seventy-six HD patients and 61 controls were examined for plaque deposits, gingivitis, periodontitis, calculus accumulation and oral health status. RESULTS: There was no statistically significant difference in the measurement of probing pocket depths (PPD) in HD and C groups, but a highly significant difference was found for plaque index (P < 0.001), gingival index (GI) (P = 0.007) and calculus surface index (P < 0.001). There was a highly significant difference for GI (P = 0.001) and PPD scores (P < 0.001) between subgroups receiving HD for <3 years or more. A positive correlation between time on dialysis and parameter of missing teeth (r = 0.259; P = 0.024), GI scores (r = 0.474; P < 0.001) and measurement of PPD (r = 0.481; P < 0.001) was found in the HD group. Decayed, missing and filled teeth index scores were higher in the controls than the HD group, with no statistical significance. CONCLUSIONS: The dental and periodontal health status of HD patients is comparable with healthy controls, but becomes worse with time on dialysis. Thus, oral health maintenance is of utmost importance in this patient group.