Burden of the Inflammatory State of Active Tuberculosis on Anemia in Patients Undergoing Maintenance Hemodialysis

Background: With the global rise in the incidence of chronic kidney disease, the number of patients undergoing hemodialysis (HD) has increased significantly. These patients frequently exhibit immune dysfunction, rendering them more susceptible to tuberculosis (TB). Anemia is a common complication associated with both conditions. Methods: This study retrospectively reviewed 95 HD patients with active TB (TB-HD) and 152 non-TB HD controls (NTB-HD) admitted to Changsha Central Hospital Affiliated with the University of South China from 2019.1 to 2024.9. We collected demographic and laboratory data results from two groups of patients . And conduct a comprehensive analysis of TB-HD patients categorized by anemia status. Results: Demographic analysis revealed significant differences in gender and duration of HD (P < 0.001). Univariate analysis indicated that TB-HD patients had significantly lower hemoglobin, red blood cell count, lymphocyte count, and albumin (ALB)etc., and higher C-reactive protein (CRP, all P < 0.05). Multivariable analysis identified female (OR 0.38, 95% CI 0.17–0.88, P<0.001) and ALB (OR 0.78 95% CI 0.72–0.86, P = 0.031) as protective factors, duration of HD (OR 1.31, 95% CI 1.14–1.50, P<0.001) and CRP (OR 1.03, 95% CI 1.01-1.04, P<0.001) was risk factors for TB infection. TB-HD patients were stratified into four anemia groups based on hemoglobin (<60, 60–90, 91–109, and 110≥g/L), with increasing severity of anemia associated with higher CRP (P < 0.001) and lower ALB. Cough and fever were common initial symptoms. Secondary pulmonary TB was the main type. Among diagnostic tests, next-generation sequencing (NGS,92.86%) and T-SPOT.TB assay(T-spot,91.55%) exhibited higher positive rates. Conclusion: Hemodialysis patients with active TB have exacerbated anemia,maily due to systemic inflammatory response. Comprehensive management (the administration of anti-TB chemotherapy and strengthening nutrition) is essential for improving anemia. We recommend that HD patients highly suspected TB prompt T-spot or NGS testing and routine screening. Funding: Clinical Revenue Support, Government Support – Non-U.S.