Clostridioides difficile infection is still a leading cause of hospital-acquired morbidity and mortality, particularly among chronically comorbid patients. Although kidney disease was previously observed to have an impact on CDI outcomes, the direct influence of ESRD and chronic kidney disease (CKD), especially with respect to IBD, has not been significantly determined. This study tried to ascertain if CKD or ESRD are independent predictors of mortality among hospitalized CDI patients and if concomitant IBD further alters this risk.
The study consisted of 133,099 hospitalized patients with CDI in the National Inpatient Sample (NIS) database from 2016 to 2018. Patient risk factors like CKD, ESRD, and IBD (Crohn's disease and ulcerative colitis) were detected using ICD-10 codes. Propensity score matching was applied to provide age- and gender-balanced comparisons as well as IBD status, creating a 1:1 exact match of 32,878 patients. Multivariable logistic regression models were used to control for confounders and to assess mortality risk across various patient subgroups.
Key Findings
• Of the 133,099 hospitalized CDI patients:
• 20,700 (15.6%) had CKD
• 12,178 (9.1%) had ESRD
• 6,104 (4.6%) had IBD
• The mean ages were 74 for CKD, 63 for ESRD, and 63 years for non-kidney disease (p<0.001).
• ESRD patients were more likely to be male (50.3%) than CKD (45.9%) and those with no kidney disease (40.8%) (p<0.001)
Mortality analysis identified:
• CKD was associated with a greater but statistically nonsignificant increase in all-cause mortality among CDI patients with IBD (OR 1.682) than those without IBD (OR 1.229; p>0.05)
• ESRD, on the other hand, was significantly related to increased mortality among CDI patients with IBD (OR 3.738, 95% CI 2.175–6.425)
• Conversely, ESRD patients without IBD had decreased mortality risk (OR 1.612, 95% CI 1.486–1.749) (p<0.05)
The study concludes that kidney disease, specifically ESRD, strongly elevates the risk of mortality in patients hospitalized with Clostridioides difficile infection, particularly if IBD also coexists. The heightened elevation in mortality in ESRD patients with IBD indicates the necessity of early diagnosis, immediate treatment, and cross-functional care in enhancing patient outcomes in this patient population at risk.
Reference:
Sleiman J, Gaballa A, Aslam T, et al. (July 16, 2025) Chronic Kidney Disease as a Predictor of Mortality in Hospitalized Inflammatory Bowel Disease Patients With Clostridioides difficile Infection. Cureus 17(7): e88113. doi:10.7759/cureus.88113
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