title: High Mortality Risk in Chronic Kidney Disease and End Stage Kidney Disease Patients with Clostridium Difficile Infection: A Systematic Review and Meta-analysis.
abstract: 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 withClostridium difficileinfection (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).
  
  
  CONCLUSIONS
  This meta-analysis demonstrates significantly increased risks of mortality in CKD and ESRD patients with CDI. The magnitudes of mortality risk are high.
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Charat
authors: C
authors: Thongprayoon
authors: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
authors: Wisit
authors: W
authors: Cheungpasitporn
authors: Department of Internal Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors: Parkpoom
authors: P
authors: Phatharacharukul
authors: Division of Infectious Disease, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors: Pailin
authors: P
authors: Mahaparn
authors: Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors: Jackrapong
authors: J
authors: Bruminhent
keywords: Clostridium Difficile Infection; Meta-analysis; chronic kidney disease; clostridium difficile; clostridium difficile-associated colitis; end stage kidney disease