Ritik M. Goyal, MBBS1, Sameer Rao, MBBS2, Anmol Mittal, MD1, Kranthi Mandava, MD1, Mohamed Ismail, DO1, Wajiha Khan, MD3, Ahmed Al-Khazraji, MD1 1Rutgers New Jersey Medical School, Newark, NJ; 2Mayo Clinic, Rochester, MN; 3Rutgers New Jersey Medical School, Cartaret, NJ
Introduction: Clostridioides difficile infection (CDI) presents with symptoms ranging from mild watery diarrhea and cramps to severe complications such as toxic megacolon and colonic perforation. Hospitalized patients on antibiotics or with comorbidities such as chronic kidney disease (CKD), inflammatory bowel disease, or immunodeficiency are particularly vulnerable. We hypothesize that CKD exacerbates complications related to CDI. To assess this impact, we compared rates of colonoscopy, colectomy, toxic megacolon, colonic perforation, shock, and respiratory failure in CDI patients with and without CKD.
Methods: We queried the National Inpatient Sample 2016-2019 database for patients admitted with a primary diagnosis of CDI using International Classification of Diseases, Tenth Revision (ICD-10) codes. Among them, we identified patients with CKD. Procedures including colonoscopy and colectomy were identified with respective ICD-10 procedure codes. Chi-square analysis determined variables for multivariable analysis. We conducted propensity-matched multivariable logistic regression to examine CDI complications adjusted for demographic and social variables (p < 0.05 significance level), using patients with concomitant CDI and CKD as cases and CDI alone as controls.
Results: Among 769,770 patients with a primary diagnosis of CDI identified, 168,400 (21.9%) had concurrent CKD. CDI patients with CKD underwent fewer colonoscopies (OR 0.891 [CI, 0.798-0.996, p = 0.043]) and colectomies (OR 0.424 [CI, 0.277-0.648, p < 0.001]). They were also less likely to experience colonic perforation (OR 0.634 [CI, 0.423-0.950, p = 0.027]). Rates of respiratory failure, shock, and toxic megacolon did not significantly differ between CDI patients with and without CKD.
Discussion: Chronic kidney disease (CKD) emerges as a prevalent comorbidity in CDI patients, previously recognized for its detrimental impact on CDI progression. Surprisingly, in our cohort, CKD was associated with reduced likelihoods of colonoscopies, colectomies, and colonic perforations. These findings suggest a potentially protective role of CKD against severe CDI complications, contrasting with prior findings. Further research is warranted to elucidate the underlying mechanisms and clinical implications of this unexpected relationship.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Ritik Goyal indicated no relevant financial relationships.
Sameer Rao indicated no relevant financial relationships.
Anmol Mittal indicated no relevant financial relationships.
Kranthi Mandava indicated no relevant financial relationships.
Mohamed Ismail indicated no relevant financial relationships.
Wajiha Khan indicated no relevant financial relationships.
Ahmed Al-Khazraji indicated no relevant financial relationships.
Ritik M. Goyal, MBBS1, Sameer Rao, MBBS2, Anmol Mittal, MD1, Kranthi Mandava, MD1, Mohamed Ismail, DO1, Wajiha Khan, MD3, Ahmed Al-Khazraji, MD1. P0205 - Impact of Chronic Kidney Disease on Complications of <i>Clostridioides difficile</i> Infection - A Population-Based Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
