Renal impairment after ileostomy formation:a frequent event with long term consequences

Fielding, Alexandra, Woods, Rebecca, Moosvi, Syed R, Wharton, Richard Q, Speakman, Christopher T M, Kapur, Sandeep, Shaikh, Irshad, Hernon, James M, Lines, Simon W and Stearns, Adam T (2020) Renal impairment after ileostomy formation:a frequent event with long term consequences. Colorectal Disease, 22 (3). pp. 269-278. ISSN 1462-8910

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Abstract

AIM: High stoma output and dehydration is common following ileostomy formation. However, the impact of this on renal function, both in the short term and after ileostomy reversal, remains poorly defined. We aimed to assess the independent impact on kidney function of an ileostomy after rectal cancer surgery, and subsequent reversibility after ileostomy closure. METHODS: This retrospective single-site cohort study identified patients undergoing rectal cancer resection from 2003-2017, with or without a diverting ileostomy. Renal function was calculated preoperatively, before ileostomy closure, and six months after ileostomy reversal (or matched times for patients without ileostomy). Demographics, oncological treatments, and nephrotoxic drug prescriptions were assessed. Outcome measures were deterioration from baseline renal function and development of moderate/ severe chronic kidney disease (CKD≥3). Multivariate analysis was performed to assess independent risk factors for postoperative renal impairment. RESULTS: 583 of 1213 patients had an ileostomy. Postoperative renal impairment occurred more frequently in ileostomates (9.5% absolute increase in rate of CKD≥3; P<0.0001) versus no change in patients without an ileostomy (P=0.757). Multivariate analysis identified ileostomy formation, age, anastomotic leak and renin-angiotensin-system inhibitors as independently associated with postoperative renal decline. Despite stoma closure, ileostomates remained at increased risk of progression to new or worse CKD (74/438 [16.9%]) compared to patients without an ileostomy (36/437 [8.2%], P=0.0001, OR 2.264 [1.49 to 3.46]). CONCLUSIONS: Ileostomy formation is independently associated with kidney injury, with an increased risk persisting after stoma closure. Strategies to protect against kidney injury may be important in higher risk patients (elderly, receiving renin-angiotensin system antihypertensives, or following anastomotic leakage).

Item Type: Article
Additional Information: Colorectal Disease © 2019 The Association of Coloproctology of Great Britain and Ireland.
Uncontrolled Keywords: digestive system,glomerular filtration rate,ileostomy,rectal neoplasms,renal insufficiency,surgical procedures,anastomotic leakage,defunctioning stoma,total mesorectal excision,ckd-epi equation,glomerular-filtration-rate,rectal-cancer,colorectal-cancer,low anterior resection,cardiovascular mortality,chronic kidney-disease,gastroenterology ,/dk/atira/pure/subjectarea/asjc/2700/2715
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Medicine and Health Sciences > School of Health Sciences
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Depositing User: LivePure Connector
Date Deposited: 01 Oct 2019 14:30
Last Modified: 12 Oct 2020 23:54
URI: https://ueaeprints.uea.ac.uk/id/eprint/72429
DOI: 10.1111/codi.14866

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