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Clostridium difficile Infection Is Associated With Poor Outcomes in End-Stage Renal Disease
  1. Chaitanya Pant, MD*,
  2. Abhishek Deshpande, MD, PhD,
  3. Michael P. Anderson, PhD,
  4. Thomas J. Sferra, MD*
  1. From the *Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK; †Neurological Institute, Cleveland Clinic, Cleveland, OH; and ‡Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
  1. Received September 22, 2011, and in revised form October 26, 2011.
  2. Accepted for publication November 14, 2011.
  3. Reprints: Thomas J. Sferra, MD, Department of Pediatrics, University of Oklahoma Health Sciences Center, 1200 N Phillips Ave, Suite 14400, Oklahoma City, OK 73104. E-mail: thomas-sferra{at}
  4. This paper was not supported by any grant.


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.

Key Words
  • Clostridium difficile infection
  • end-stage renal disease
  • hospital charges
  • length of stay
  • mortality
  • Nationwide Inpatient Sample (NIS) database

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