Key Points

CKD is associated with a higher risk of tuberculosis.We produced nationwide estimates of tuberculosis incidence and mortality associated with kidney failure.Tuberculosis incidence ranged from 26.1 to 45.4 per 100,000 people with kidney failure, and nearly 40% died before diagnosis or during treatment.

Background

People with CKD have a higher risk of progression to tuberculosis disease after infection with Mycobacterium tuberculosis. We produced a nationwide incidence estimate and description of tuberculosis among people with kidney failure.

Methods

We completed a cross-sectional descriptive analysis of people with a reported case of tuberculosis in the United States between 2010 and 2021. We stratified all people with tuberculosis by reported kidney failure status. The primary outcome was tuberculosis incidence among people with kidney failure. We also compared characteristics of people with tuberculosis by reported kidney failure status.

Results

Approximately 3% of people (2892 of 111,155) diagnosed with tuberculosis between 2010 and 2021 also had kidney failure. Annual tuberculosis incidence ranged from 26.1 to 45.4 per 100,000 people with kidney failure and 2.1 to 3.5 per 100,000 people without kidney failure. Among people with kidney failure, 924 (32%) had extrapulmonary tuberculosis only and nearly 40% died: 286 were diagnosed with tuberculosis after death, and 792 died during treatment. People with tuberculosis and kidney failure had approximately twice the prevalence of a false-negative tuberculin skin test result (39%) compared with people with tuberculosis alone (20%).

Conclusions

Tuberculosis incidence among people with kidney failure between 2010 and 2021 in the United States was ten-fold that among people without kidney failure.