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Abstract: PO2352

CKD and Risk of Incident Hospitalization with Clostridioides difficile Infection: Findings from the Atherosclerosis Risk in Communities Study

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Ishigami, Junichi, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Grams, Morgan, Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Chang, Alex R., Geisinger Health, Danville, Pennsylvania, United States
  • Lutsey, Pamela L., University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
  • Levey, Andrew S., Tufts Medical Center, Boston, Massachusetts, United States
  • Coresh, Josef, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Dowdy, David W., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Matsushita, Kunihiro, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
Background

Clostridioides difficile (C. difficile) infection is a major public health priority in the US. Individuals with CKD are at high risk of infection and hospitalization in general; however, the association of CKD with the risk of C. difficile disease has not been systematically evaluated.

Methods

We evaluated data from 11,017 participants of the ARIC Study (mean age, 63 years; 56% female; 22% Black) to explore the association of CKD with the risk of incident hospitalization with C. difficile infection. We categorized the study population into four risk categories defined by eGFR and ACR: CKD was defined as eGFR <60 ml/min/1.73m2 or ACR ≥30 mg/g, and no CKD was defined as low risk. CKD was subdivided into moderate, high, and very high risk. Adjusted HRs were estimated using Cox regression models.

Results

During a median follow-up of 20.1 years, 309 participants had incident hospitalization with C. difficile infection. In multivariable Cox regression analysis, there was a graded association of CKD risk category with the risk of hospitalization with C. difficile infection, with adjusted HRs of 4.74 [2.29 to 10.23] for CKD with very high risk, 2.33 [1.39 to 3.90] for CKD with high risk, and 1.34 [0.93 to 1.93] for CKD with moderate risk compared to no CKD (P-for-linear-trend, <0.001) (Figure 1). These findings were consistent in subgroup analyses and sensitivity analyses, including analyses that accounted for frequency of prior hospitalization and for the risk of hospitalization itself.

Conclusion

In this community-based cohort, CKD was associated with the risk of hospitalization with C. difficile infection. Individuals with CKD should be a key target population for public health initiatives and clinical approaches to prevent C. difficile infection.