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The Risks of Incident and Recurrent Clostridium difficile-Associated Diarrhea in Chronic Kidney Disease and End-Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis

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Abstract

Background

The objective of this systematic review and meta-analysis was to assess the risks of incident and recurrent Clostridium difficile-associated diarrhea in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) requiring dialysis.

Methods

A literature search was performed from inception to February 2015. Studies that reported relative risks, odds ratios, or hazard ratios comparing the risks of C. difficile-associated diarrhea in patients with CKD or ESRD versus 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

Twenty studies (nine case–control, seven cohort, and four cross-sectional studies with 162,218,041 patients) were included in the meta-analysis. Pooled RRs of C. difficile-associated diarrhea in patients with CKD and ESRD were 1.95 (95 % CI 1.81–2.10) and 2.63 (95 % CI 2.04–3.38), respectively. When meta-analysis was limited only to cohort and case–control studies with confounder-adjusted analysis, the pooled RRs of C. difficile-associated diarrhea in patients with CKD and ESRD were 1.89 (95 % CI 1.75–2.05) and 2.50 (95 % CI 1.49–4.17), respectively. The pooled RR of recurrent C. difficile-associated diarrhea in patients with CKD was 2.61 (95 % CI 1.53–4.44). Data on the risk of recurrent C. difficile-associated diarrhea were limited.

Conclusion

This meta-analysis demonstrates significantly increased risks of incident and recurrent C. difficile-associated diarrhea in patients with CKD. Furthermore, the magnitude of increased risk of C. difficile-associated diarrhea in ESRD patients is even higher.

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Conflict of interest

We do not have any financial or non-financial potential conflicts of interest.

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Authors and Affiliations

  1. Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA

    Parkpoom Phatharacharukul

  2. Division of Nephrology and Hypertension, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Charat Thongprayoon & Wisit Cheungpasitporn

  3. SUNY Upstate Medical University, Syracuse, NY, USA

    Peter J. Edmonds

  4. Division of Infectious Disease, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Pailin Mahaparn

  5. Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Jackrapong Bruminhent

Authors
  1. Parkpoom Phatharacharukul
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  2. Charat Thongprayoon
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  3. Wisit Cheungpasitporn
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  4. Peter J. Edmonds
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  5. Pailin Mahaparn
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Correspondence to Wisit Cheungpasitporn.

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Phatharacharukul, P., Thongprayoon, C., Cheungpasitporn, W. et al. The Risks of Incident and Recurrent Clostridium difficile-Associated Diarrhea in Chronic Kidney Disease and End-Stage Kidney Disease Patients: A Systematic Review and Meta-Analysis. Dig Dis Sci 60, 2913–2922 (2015). https://doi.org/10.1007/s10620-015-3714-9

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