Clostridium difficile Infection is Associated with Poor Outcomes in End-Stage Renal Disease

OBJECTIVE: To investigate the association of Clostridium difficile infection (CDI) with the outcomes of hospitalized patients with end-stage renal disease (ESRD). METHODS: We extracted all adult cases with a discharge diagnosis of ESRD or CDI from the United States Nationwide Inpatient Sample 2009 database. Outcome variables (mortality, length of hospital stay LOS, and hospitalization charges), demographic information, and comorbidity data were collected. Data were evaluated by univariate and multiple regression analyses. RESULTS: We identified 184, 139 cases with ESRD of which 2. 8% had CDI. Comparison of patients with ESRD + CDI to those with only ESRD revealed in-hospital mortality (13. 2% vs 5. 3%; P < 0. 001), LOS (17. 3 vs 7. 1 days; P < 0. 001), and charges (124, 846 vs 56, 663; P < 0. 001) to be more than 2-fold greater. In the ESRD cohort (ESRD only and ESRD + CDI), CDI was independently associated with greater mortality (adjusted odds ratio, 2. 15; 95% CI, 2. 07-2. 24; P < 0. 001), longer LOS (mean difference, 9. 4 days; 95% CI, 9. 2-9. 5; P < 0. 001), and higher charges (mean difference, 62, 824; 95% CI, 61, 615-64, 033; P < 0. 001). CONCLUSIONS: Clostridium difficile infection is associated with significantly worse outcomes in hospitalized patients with ESRD.