The Burden of the Inflammatory State of Tuberculosis and Malnutrition on Anemia in Patients Undergoing Maintenance Hemodialysis

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Abstract

Background and Objective: With the global rise in the incidence of chronic kidney disease (CKD), the number of patients receiving hemodialysis (HD) has also increased. These patients often exhibit immune dysfunction, making them more vulnerable to tuberculosis (TB) infection. Anemia is a common complication in both conditions. This study aims to investigate the clinical characteristics of TB in patients undergoing HD, and explore the relationships among inflammation, nutrition, and anemia. Methods This retrospective study included 95 HD patients diagnosed with TB (TB-HD group) and 152 HD patients without TB (NTB-HD group), all admitted to Changsha Central Hospital affiliated with the University of South China between January 2019 and September 2024. Results Significant differences in gender and HD duration were noted between the two groups (P < 0.001). Univariate analysis showed that TB-HD patients had significantly lower hemoglobin (Hb), red blood cell count, lymphocyte count and albumin (ALB), and higher C-reactive protein (CRP) (all P < 0.05). Multivariable analysis identified female sex (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, while longer HD duration (OR = 1.31, 95% CI: 1.14–1.50, P < 0.001) and elevated CRP (OR = 1.03, 95% CI: 1.01–1.04, P < 0.001) increased TB infection risk in HD patients. TB-HD patients were stratified into four anemia categories by Hb levels (< 60, 60–90, 91–109, ≥ 110 g/L), with more severe anemia associated with higher CRP (P < 0.001). Correlation analysis showed a significant negative correlation between CRP and Hb (TB-HD: R = -0.39; NTB-HD: R = -0.13; both P < 0.01), with a stronger correlation in the TB-HD group. CRP was also negatively correlated with ALB (TB-HD: R = -0.48; NTB-HD: R = -0.29; both P < 0.01), while ALB was positively correlated with Hb (TB-HD: R = 0.49; NTB-HD: R = 0.33; both P < 0.01). Conclusion Patients on maintenance hemodialysis (MHD) who develop TB often experience worsened anemia, which is closely linked to systemic inflammation (elevated CRP) and malnutrition (reduced ALB). These factors contribute to a vicious cycle of inflammation–malnutrition–anemia .

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