Detecting Tuberculosis by Quantiferon TB Gold Plus Assay and its Comparison with Mantoux Test in Chronic Kidney Disease Patients

Open Access

Abstract

Background: Patients with chronic kidney disease (CKD) are at increased risk of tuberculosis (TB) because of impaired cellular immunity associated with uraemia, dialysis, and immunosuppressive therapy following kidney transplantation. Conventional tuberculin skin testing using the Mantoux test may have limited sensitivity in immunocompromised patients. This study aimed to detect latent and active tuberculosis among CKD patients and compare the performance of the QuantiFERON-TB Gold Plus (QFT-Plus) assay with the Mantoux test. Methods & Materials: This cross-sectional study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from January to December 2019. A total of 103 adult CKD patients, including those receiving conservative management, hemodialysis, peritoneal dialysis, and kidney transplantation, were enrolled using purposive sampling. Demographic, clinical, and laboratory data were collected using a structured questionnaire. Participants were evaluated using QFT-Plus and the Mantoux test. Data were analyzed using SPSS version 23, and a p-value <0.05 was considered statistically significant. Results: Of the 103 participants, 54 (52.4%) had no evidence of TB, 40 (38.8%) had latent TB, and 9 (8.7%) had active TB disease. QFT-Plus was positive in 49 (47.6%) patients, whereas only 17 (16.5%) were Mantoux-positive. All Mantoux-positive patients were also QFT-positive; however, QFT-Plus identified an additional 32 (31.1%) patients who were Mantoux-negative (p<0.001). TB was significantly more frequent among kidney transplant recipients than among patients receiving conservative management (64.0% vs. 33.3%, p=0.023). Conclusion: Tuberculosis, particularly latent TB infection, was highly prevalent among patients with advanced CKD. QFT-Plus detected substantially more TB infection than the Mantoux test and may be a more useful screening tool in this immunocompromised population.