Tuberculosis screening in a dialysis unit: detecting latent tuberculosis infection is only half the problem.

Patients with chronic kidney disease are at increased risk of tuberculosis. We describe the events that occurred when we encountered a patient receiving haemodialysis with pulmonary tuberculosis. Nine (of 41) patients dialysing at the same time as the index case had a positive interferon-gamma release assay (IGRA) and were offered therapy for latent tuberculosis infection (LTBI). Patients with an initial negative IGRA were rescreened at six months, identifying a further three IGRA-positive patients. All patients were then rescreened at 12 months. No new IGRA-positive cases were identified and no staff or patients developed active disease. Only five of the 12 IGRA-positive patients completed LTBI therapy.