title: Chronic kidney disease and end-stage renal disease are risk factors for poor outcomes of Clostridium difficile infection: a systematic review and meta-analysis.
abstract: BACKGROUND
  The objective of this systematic review and meta-analysis was to assess the clinical outcomes of Clostridium difficile infection (CDI) in patients with chronic kidney diseases (CKD) and end-stage renal disease (ESRD).
  
  
  METHODS
  A literature search was performed from inception through February 2015. Studies that reported relative risks, odds ratios or hazard ratios comparing the clinical outcomes of CDI in patients with CKD or ESRD and those without CKD or ESRD were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.
  
  
  RESULTS
  Nineteen studies (a case-control and 18 cohort studies) with 116,875 patients assessing clinical outcomes of CDI were included in the meta-analysis. Pooled RR of severe or complicated CDI in CKD patients was 1.51 (95% CI: 1.00-2.28). The risk of recurrent CDI is significant higher in patients with a pooled RR of 2.73 (95% CI: 1.36-5.47). The pooled RR of mortality risk of CDI in patients with CKD, ESRD and CKD or ESRD were 1.76 (95% CI: 1.26-2.47), 1.58 (1.37-1.83) and 1.76 (1.32-2.34) respectively.
  
  
  CONCLUSIONS
  This meta-analysis demonstrates poor outcomes of CDI including severe and recurrent CDI in CKD patients. History of CKD and ESRD are both associated with increased mortality risk in patients with CDI.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: W
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: P
authors.initials: P
authors.lastname: Phatharacharukul
authors.affiliation: SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: P J
authors.initials: PJ
authors.lastname: Edmonds
authors.affiliation: Division of Infectious Disease, University of Texas Medical School at Houston, Houston, TX, USA.
authors.forename: Q
authors.initials: Q
authors.lastname: Kaewpoowat
authors.affiliation: Division of Infectious Disease, Chulalongkorn University, Bangkok, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Mahaparn
authors.affiliation: Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Bruminhent
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Erickson
mesh_terms: D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D012307:Risk Factors