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Detection of latent tuberculosis infection in hemodialysis patients: Comparison between the quantiferon-tuberculosis gold test and the tuberculin skin test



Tuberculosis (TB) remains an important cause of morbidity and mortality in hemodialysis (HD) patients. A gold standard for the diagnosis of latent tuberculosis infection (LTBI) is lacking.


The aim of this study was to compare the diagnostic utility of the QuantiFERON-Tuberculosis Gold (QFT-G) test with the tuberculin skin test (TST) in identifying LTBI in patients with end-stage renal disease (ESRD) on HD.

Study design

The present study had a prospective design.

Patients and methods

A total of 74 patients with ESRD on HD without active TB and other immunosuppressive conditions were tested for LTBI by the QFT-G test and the TST.


LTBI, as estimated by the QFT-G test and TST, was detected in 35.1 and 13.5% of the HD patients, respectively; 37.8% of patients were positive for the QFT-G test and/or the TST. There was a poor agreement between QFT-G test and TST results in patients with ESRD on HD (QFT-G test vs. TST: κ=0.25, 95% confidence interval=0.12–0.37). TST was positive in 2.7% of patients when the QFT-G test was negative, and it was negative in 24.3% of patients when the QFT-G test was positive. There was no significant difference in duration of HD or creatinine levels between QFT-G-positive and QFT-G-negative patients (P=0.08 and 0.2, respectively). TST-positive patients had a significantly shorter duration of HD and lower creatinine levels than TST-negative patients (P=0.001 and 0.01, respectively).


In patients with ESRD and on HD, LTBI cannot be simply ruled out with a negative TST result, but rather a QFT-G test is recommended. Screening and treatment of LTBI should be carried in dialysis patients, aiming to prevent progression to active TB and secondary infection of others.


  1. National TB Control Program. Guidelines on management of tuberculosis for non-chest physicians. Egypt: Ministry of Health and Population; 2008.

  2. Shaheen FA, Al-Khader AA. Preventive strategies of renal failure in the Arab world. Kidney Int Suppl 2005; 98:S37–S40.

    Article  Google Scholar 

  3. American Thoracic Society; Centers for Disease Control and Prevention. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 2000; 161(Suppl):221–247

  4. World Health Organization. Global tuberculosis report 2015. Geneva: WHO; 2015. Available at: [Accessed 23 November 2015].

  5. Passalent L, Khan K, Richardson R, Wang J, Dedier H, Gardam M. Detecting latent tuberculosis infection in hemodialysis patients: a head-to-head comparison of the T-SPOT. TB test, tuberculin skin test, and an expert physician panel. Clin J Am Soc Nephrol 2007; 2:68–73.

    Article  Google Scholar 

  6. Hussein MM, Mooij JM, Roujouleh H. Tuberculosis and chronic renal disease. Semin Dial. 2003; 16:38–44.

  7. Abdelrahman M, Sinha AK, Karkar A. Tuberculosis in end-stage renal disease patients on hemodialysis. Hemodial Int 2006; 10:360–364.

    Article  Google Scholar 

  8. Segall L, Covic A. Diagnosis of tuberculosis in dialysis patients: current strategy. Clin J Am Soc Nephrol 2010; 5:1114–1122.

    Article  CAS  Google Scholar 

  9. Ai JW, Ruan QL, Liu QH, Zhang WH. Updates on the risk factors for latent tuberculosis reactivation and their managements. Emerg Microbes Infect 2016; 5:e10.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Gerogianni I, Papala M, Klapsa D, Zinzaras E, Petinaki E, Gourgoulianis KI. Whole-blood interferon-gamma assay for the diagnosis of tuberculosis infection in an unselected Greek population. Respirology 2008; 13: 270–274.

    Article  Google Scholar 

  11. Kraemer HC. Measurement of reliability for categorical data in medical research. Stat Methods Med Res 1992; 1:183–199.

    Article  CAS  Google Scholar 

  12. Bloch AB. Screening for tuberculosis and tuberculosis infection in high-risk populations recommendations of the advisory council for the elimination of tuberculosis. MMWR 1995; 44:19–34.

  13. Andersen P, Munk ME, Pollock JM, Doherty TM. Specific immune-based diagnosis of tuberculosis. Lancet 2000; 356:1099–1104.

  14. Lalvani A, Pathan AA, McShane H,Wilkinson RJ, Latif M, Conlon CP, et al. Rapid detection of Mycobacterium tuberculosis infection by enumeration of antigen-specific T cells. Am J Respir Crit Care Med 2001; 163:824–828.

    Article  CAS  Google Scholar 

  15. Abdel-Nabia EA, Eissaa SA, Solimana YMA, Amin WA. Quantiferon vs. tuberculin testing in detection of latent tuberculous infection among chronic renal failure patients. Egypt J Chest Dis Tuberc 2014; 63:161–165.

    Article  Google Scholar 

  16. Ates G, Ozekinci T, Yildiz T, Danis R. Comparison of interferon-gamma release assay versus tuberculin skin test for latent tuberculosis screening in hemodialysis patients. Biotechnol Biotechnol Equip 2009; 23: 1242–1246.

    Article  Google Scholar 

  17. Hoffmann M, Tsinalis D, Vernazza P, Fierz W, Binet I. Assessment of an interferon-gamma release assay for the diagnosis of latent tuberculosis infection in haemodialysis patient. Swiss Med Wkly 2010; 140:286–292.

    CAS  PubMed  Google Scholar 

  18. Inoue T, Nakamura T, Katsuma A, Masumoto S, Minami E, Katagiri D, et al. Value of QuantiFERON TB-Gold in the diagnosis of tuberculosis among dialysis patients. Nephrol Dial Transplant 2009; 24:2252–2257.

    Article  Google Scholar 

  19. Sagheb MM, Goodarzi M, Roozbeh J. The booster phenomenon of tuberculin skin testing in patients receiving hemodialysis. Iran J Immunol 2008; 5:212–216.

    PubMed  Google Scholar 

  20. Lee SS, Chou KJ, Su IJ, Chen YS, Fang HC, Huang TS, et al. High prevalence of latent tuberculosis infection in patients in end-stage renal disease on hemodialysis: comparison of QuantiFERON-TB GOLD, ELISPOT, and tuberculin skin test. Infection 2009; 37:96–102.

    Article  CAS  Google Scholar 

  21. Lee SS-J, Chou K-J, Dou H-Y, Huang T-S, Ni Y-Y, Fang H-C, et al. High prevalence of latent tuberculosis infection in dialysis patients using the interferon-γ release assay and tuberculin skin test. Clin J Am Soc Nephrol 2010; 5:1451–1457.

    Article  Google Scholar 

  22. Centers for Disease Control and Prevention. Tuberculosis transmission in a Renal Dialysis Center – Nevada, 2003. MMWR 2004; 53:873–875.

  23. Triverio PA, Bridevaux PO, Roux-Lombard P, Niksic L, Rochat T, Martin PY, et al. Interferon-gamma release assays versus tuberculin skin testing for detection of latent tuberculosis in chronic haemodialysis patients. Nephrol Dial Transplant 2009; 24:1952–1956.

    Article  CAS  Google Scholar 

  24. Chung WK, Zheng ZL, Sung JY, Kim S, Lee HH, Choi SJ, et al. Validity of interferon-γ-release assays for the diagnosis of latent tuberculosis in haemodialysis patients. Clin Microbiol Infect 2010; 16:960–965.

    Article  CAS  Google Scholar 

  25. Winthrop KL, Nyendak M, Calvet H, Oh P, Lo M, Swarbrick G, et al. Interferon-gamma release assays for diagnosing Mycobacterium tuberculosis infection in renal dialysis patients. Clin J Am Soc Nephrol 2008; 3:1357–1363.

    Article  Google Scholar 

  26. Shankar MS, Aravindan AN, Sohal PM, Kohli HS, Sud K, Gupta KL, et al. The prevalence of tuberculin sensitivity and anergy in chronic renal failure in an endemic area: tuberculin test and the risk of post-transplant tuberculosis. Nephrol Dial Transplant 2005; 20:2720–2724.

    Article  Google Scholar 

  27. Huebner RE, Schein MF, Bass JB Jr. The tuberculin skin test. Clin Infect Dis 1993; 17:968–975.

  28. Farhat M, Greenaway C, Pai M, Menzies D. False-positive tuberculin skin tests: what is the absolute effect of BCG and non-tuberculous mycobacteria? Int J Tuberc Lung Dis 2006; 10:1192–1204.

    CAS  PubMed  Google Scholar 

  29. Abdel-Samea SA, Ismail YM, Fayed SM, Mohammad AA. Comparative study between using QuantiFERON and tuberculin skin test in diagnosis of Mycobacterium tuberculosis infection. Egypt J Chest Dis Tuberc 2013; 62:137–143.

    Article  Google Scholar 

  30. Helmya N, Abdel latif S, Kamela MM, Ashoura W, El Kattana E. Role of Quantiferon TB gold assays in monitoring the efficacy of antituberculosis therapy. Egypt J Chest Dis Tuberc 2012; 61:329–336.

    Article  Google Scholar 

  31. Lalvani A, Pareek M. A 100 year update on diagnosis of tuberculosis infection. Br Med Bull 2010; 93:69–84.

    Article  Google Scholar 

  32. Stephan C, Wolf T, Goetsch U, Bellinger O, Nisius G, Oremek G, et al. Comparing QuantiFERON-tuberculosis gold, T-SPOT tuberculosis and tuberculin skin test in HIV-infected individuals from a low prevalence tuberculosis country. AIDS 2008; 22:2471–2479.

    Article  Google Scholar 

  33. Luetkemeyer AF, Charlebois ED, Flores LL, Bangsberg DR, Deeks SG, Martin JN, et al. Comparison of an interferon-gamma release assay with tuberculin skin testing in HIV-infected individuals. Am J Respir Crit Care Med 2007; 175:737–742.

    Article  Google Scholar 

  34. Raby E, Moyo M, Devendra A, Banda J, De Haas P, Ayles H, Godfrey-Faussett P. The effects of HIV on the sensitivity of a whole blood IFN-gamma release assay in Zambian adults with active tuberculosis. PLoS One 2008; 3:e2489.

    Article  Google Scholar 

  35. Richeldi L. An update on the diagnosis of tuberculosis infection. Am J Respir Crit Care Med 2006; 174:736–742.

  36. Metcalfe JZ, Everett CK, Steingart KR, Cattamanchi A, Huang L, Hopewell PC, et al. Interferon-γ release assays for active pulmonary tuberculosis diagnosis in adults in low- and middle-income countries: systematic review and meta-analysis. J Infect Dis 2011; 204(Suppl 4): S1120–S1129.

  37. Rangaka MX, Wilkinson KA, Glynn JR, Ling D, Menzies D, Mwansa-Kambafwile J, et al. Predictive value of interferon-γ release assays for incident active tuberculosis: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12:45–55.

    Article  CAS  Google Scholar 

  38. Lagrange PH, Simonney N, Herrmann JL. New immunological tests in the diagnosis of tuberculosis. Rev Mal Respir 2007; 24(Part 1): 453–472.

  39. British Thoracic Society Standards of Care Committee, Joint Tuberculosis Committee, Milburn H, Ashman N, Davies P, Doffman S, Drobniewski F, Khoo S, et al. Guidelines for prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease. Thorax 2010; 65:557–570.

    Article  Google Scholar 

  40. Prevention Committee of the Japanese Society for Tuberculosis, Treatment Committee of the Japanese Society for Tuberculosis. Treatment guidelines for latent tuberculosis infection. Kekkaku 2014; 89:21–37.

    Google Scholar 

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Correspondence to Mona T. Hussein MD.

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Hussein, M.T., Yousef, L.M. & Ali, A.T. Detection of latent tuberculosis infection in hemodialysis patients: Comparison between the quantiferon-tuberculosis gold test and the tuberculin skin test. Egypt J Bronchol 11, 255–259 (2017).

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