High Mortality Risk in Chronic Kidney Disease and End Stage Kidney Disease Patients with Clostridium Difficile Infection: A Systematic Review and Meta-analysis

Charat Thongprayoon, Wisit Cheungpasitporn, Parkpoom Phatharacharukul, Pailin Mahaparn, Jackrapong Bruminhent

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA. Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA. Division of Infectious Disease, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.


BACKGROUND: The objective of this systematic review and meta-analysis was to evaluate the mortality risk in patients with chronic kidney diseases (CKD) and end stage renal disease (ESRD) requiring dialysis with Clostridium difficile infection (CDI).

METHODS: A literature search was performed from inception through February 2015. Studies that reported relative risks, odds ratios, or hazard ratios comparing the mortality risk of CKD or ESRD patients with CDI versus those without CDI were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.  

RESULTS: Four cohort studies with 8,214,676 patients were included in the meta-analysis. Pooled RR of mortality in CKD patients with CDI was 1.73 (95% CI 1.39–2.15). When meta-analysis was limited only to included studies with ESRD patients, the pooled RR of mortality in patients with ESRD was 2.15 (95% CI, 2.07-2.23).

CONCLUSION: This meta-analysis demonstrates significantly increased risks of mortality in CKD and ESRD patients with CDI. The magnitudes of mortality risk are high. Journal of Nature and Science, 1(4):e85, 2015

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