P156 London based pilot study screening new starters of dialysis for latent tuberculosis infection (LTBI)

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Background Latent TB infection (LTBI) remains an important reservoir of TB even in low incidence countries. The prevalence of latent infection is higher in patients with chronic kidney disease and those receiving dialysis.1 Those with LTBI on renal replacement therapy (RRT) are known to have higher risks of reactivation to active disease.2 Our centre data has shown risk is highest within the first 24 months of initiating RRT. At present there is no uniform TB screening and with ad hoc testing by clinicians. Aim Feasibility and yield of screening new dialysis starters for LTBI with a QuantiFERON blood test. Methods This analysis is between the period 1st May 2021 and 30th April 2022 at our group of West London based dialysis centres as we started to implement this new pathway. Within the first three months of dialysis initiation a QuantiFERON blood test is included as part of routine initiation or monthly infection screening. Positive and recurrent indeterminate results are referred to the TB service. Comorbidities and individual risk factors are collected through electronic patient records. Results 464 patients have started dialysis during this time. 371 haemodialysis patients, 93 peritoneal dialysis. There has been a gradual increase in monthly QuantiFERON testing as awareness of the pilot has increased (6–17 tests performed per month). 107/464 (23%) patients have now had a QuantiFERON test. A schematic of the results are shown in the figure below. Conclusions Our pilot has shown routine testing for LTBI can be implemented in this high risk group and has allowed a significant proportion (14%) of high risk individuals to be assessed by a TB clinician and the multi-disciplinary team. Suitable patients are offered latent TB treatment or may be investigated for active infection. References Getahun, H., Matteelli, A., Chaisson, R.E., Raviglione, M., 2015. Latent Mycobacterium tuberculosis Infection. New England Journal of Medicine 372, 2127–2135. doi:10.1056/nejmra1405427 Horsburgh CR Jr, Rubin EJ. Clinical practice. Latent tuberculosis infection in the United States. N Engl J Med. 2011 Apr 14;364(15):1441–8. doi: 10.1056/NEJMcp1005750. PMID: 21488766.

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