title: Advanced chronic kidney disease: a strong risk factor for Clostridium difficile infection.
abstract: OBJECTIVE
  It has been suggested that chronic kidney disease (CKD) is a risk factor for Clostridium difficile infection (CDI) and is associated with increased mortality among patients infected with C. difficile. However, recent studies of the clinical impact of CKD on CDI in Asians are still insufficient. We sought to determine the relationship between CKD and CDI in a Korean population.
  
  
  METHODS
  This was a single-center, retrospective case-control study. In total, 171 patients with CDI were included as cases and 342 age- and gender-matched patients without CDI were used as controls. We compared the prevalence of CKD in the study sample and identified independent risk factors that could predict the development or prognosis of CDI.
  
  
  RESULTS
  Independent risk factors for CDI included stage IV to V CKD not requiring dialysis (odds ratio [OR], 2.90) and end-stage renal disease requiring dialysis (OR, 3.34). Patients with more advanced CKD (estimated glomerular filtration rate < 30) and CDI showed higher in-hospital mortality and poorer responses to the initial metronidazole therapy.
  
  
  CONCLUSIONS
  More advanced CKD is an independent risk factor for CDI and is associated with higher in-hospital mortality and poor treatment responses in CDI patients. Thus, in CKD patients, careful attention should be paid to the occurrence of CDI and its management to improve the outcome of CDI.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Sun Chul
authors.initials: SC
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Min Young
authors.initials: MY
authors.lastname: Seo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Eunjung
authors.initials: E
authors.lastname: Cho
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Myung-Gyu
authors.initials: MG
authors.lastname: Kim
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Sang-Kyung
authors.initials: SK
authors.lastname: Jo
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Won-Yong
authors.initials: WY
authors.lastname: Cho
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea.
authors.forename: Hyoung-Kyu
authors.initials: HK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D016360:Clostridioides difficile / Q000472:pathogenicity*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole
keywords: Clostridium difficile; Dialysis; Renal insufficiency, chronic; Risk factors