Acute kidney injury is a common and significant complication following ileostomy formation

Loria, Anthony; Melucci, Alexa D.; Speranza, Jenny R.; Cellini, Christina; Salloum, Rabih M.; Temple, Larissa K.; Fleming, Fergal J.; Justiniano, Carla F.

doi:10.1111/codi.15917

Cited by 9 publications

(10 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the present study, the outcomes were derived entirely from registry data, relying on clinicians to state a correct diagnosis that is subsequently captured accurately by the National Patient Registry. This inevitably leads to misclassification, albeit in all likelihood non-differential in nature; judging from the comparably low proportions of renal failure in this study compared with others 27 , it is probable that the true rate of renal failure in this cohort is higher than the registered rate; the exclusion of older and more co-morbid patients certainly contributed to the low rates. However, such misclassification would likely lead to dilution of the association towards the null hypothesis, whereas this study still displayed clear effects of defunctioning stoma use on renal failure.…”

Section: Discussionmentioning

confidence: 51%

Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure: nationwide population-based study

et al. 2023

View full text Add to dashboard Cite

Background Electrolyte disturbances and dehydration are common after anterior resection for rectal cancer with a defunctioning loop ileostomy. High-quality population-based studies on the impact of a defunctioning loop ileostomy on renal failure are lacking. Methods This was a nationwide observational study, based on the Swedish Colorectal Cancer Registry of patients undergoing anterior resection for rectal cancer between 2008 and 2016, with follow-up until 2017. Patients with severe co-morbidity, with age greater than 80 years, and with pre-existing renal failure were excluded. Loop ileostomy at index surgery constituted exposure, while a diagnosis of renal failure was the outcome. Acute and chronic events were analysed separately. Inverse probability weighting with adjustment for confounding derived from a causal diagram was employed. Hazards ratios (HRs) with 95 per cent c.i. are reported. Results A total of 5355 patients were eligible for analysis. At 5-year follow-up, all renal failure events (acute and chronic) were 7.2 per cent and 3.3 per cent in the defunctioning stoma and no stoma groups respectively. In the weighted analysis, a HR of 11.59 (95 per cent c.i. 5.68 to 23.65) for renal failure in ostomates was detected at 1 year, with the largest effect from acute renal failure (HR 24.04 (95 per cent c.i. 8.38 to 68.93)). Later follow-up demonstrated a similar pattern, but with smaller effect sizes. Conclusion Patients having a loop ileostomy in combination with anterior resection for rectal cancer are more likely to have renal failure, especially early after surgery. Strategies are needed, such as careful fluid management protocols, and further research into alternative stoma types or reduction in stoma formation.

show abstract

Section: Discussionmentioning

confidence: 51%

Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure: nationwide population-based study

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Moreover, several do not examine preoperative laboratory factors available in NSQIP associated with postoperative AKI [7][8][9]. This is notable because a postoperative AKI increases the odds of readmission for dehydration in patients with ileostomies [11]. To mitigate case acuity and diagnostic heterogeneity, we restricted our analysis to patients with rectal cancer undergoing an elective left-sided b Anaemia: haematocrit <36% for women and <39% for men.…”

Section: Discussionmentioning

confidence: 99%

“…For patients with ileostomies, dehydration is common and associated with acute and chronic kidney disease [6][7][8][9][10][11][12][13][14]. Studies comparing ileostomies to colostomies in the context of rectal cancer emphasize differences in herniation, pouching difficulties and wound infections [3,4,[15][16][17][18][19].…”

mentioning

confidence: 99%

Major renal morbidity following elective rectal cancer resection by the type of diverting ostomy

et al. 2022

Self Cite

View full text Add to dashboard Cite

Aim Patients with rectal cancer often undergo faecal diversion, yet the existing literature cursorily reports renal sequelae by the type of ostomy. We aimed to determine whether the presence of an ileostomy or colostomy was associated with postoperative renal morbidity. Methods We identified patients with rectal cancer undergoing elective resection with primary anastomosis without diversion, with an ileostomy and with a colostomy by 21 possible procedures in the colectomy‐ and proctectomy‐specific National Surgical Quality Improvement Program files. The odds of major renal events (renal failure [dialysis initiated] or progressive renal insufficiency [>2 mg/dl increase in creatinine without dialysis]), progressive renal insufficiency alone and readmissions were assessed using propensity score weighting and logistic regression. Results Of 15 075 patients (63.7% Stage II–III, 85.7% creatinine values obtained ≤30 days preoperatively), 37.7% were not diverted, 39.5% had an ileostomy and 22.9% a colostomy. Compared to non‐diverted patients, diversion was associated with major renal events (ileostomy, odds ratio [OR] 2.1, 95% confidence interval [CI] 1.6–2.9; colostomy, OR 1.8, 95% CI 1.3–2.5), progressive renal insufficiency (ileostomy, OR 2.5, 95% CI 1.7–3.5; colostomy, OR 2.0, 95% CI 1.4–2.9), readmissions for renal failure (ileostomy, OR 3.2, 95% CI 2.1–5.0; colostomy, OR 2.5, 95% CI 1.6–4.1) and readmissions for fluid/electrolyte abnormalities (ileostomy, OR 2.3, 95% CI 1.6–3.3; colostomy, OR 1.8, 95% CI 1.2–2.6). Conclusion Diverting ostomies after elective rectal cancer resection are strongly associated with renal morbidity. The decision to divert is complex, and it is unclear whether select patients may benefit from a colostomy from a renal perspective.

show abstract

“…Nearly 80% of those readmitted with dehydration at 30 days have a concomitant AKI. 4 In the 3 months after ileostomy formation, 15% of patients experience a de novo or community-onset AKI, and of those, 28.5% develop stage III CKD within 12 months. 5 After ileostomy takedown, the risk of incident CKD is attenuated, but it remains significantly elevated among those who had an ileostomy-associated AKI.…”

Section: Patients With Ileostomiesmentioning

confidence: 99%

Postoperative Acute Kidney Injury in Colorectal Surgery

Loria

Fleming

2022

Diseases of the Colon &Amp; Rectum

Self Cite

View full text Add to dashboard Cite

A 73-year-old woman with hypertension controlled by an angiotensin-converting enzyme inhibitor (ACEi) undergoes a laparoscopic converted to open low anterior resection with diverting loop ileostomy (DLI) for locally advanced rectal adenocarcinoma. On postoperative day 5, her serum creatinine (sCr) is 1.4 mg/dL compared to a baseline of 0.9 mg/dL. Nonsteroidal anti-inflammatory drugs (NSAIDs) are stopped, she is resuscitated with balanced crystalloid until her sCr returns to the nadir, and she is discharged. At her postoperative visit, she has mild tachycardia and reports 1 week of 1500 to 2000 mL/ day of ileostomy output. She is admitted with an sCr of 2.4 mg/dL and a blood urea nitrogen of 50. She is discharged after infectious complications are excluded, her ileostomy output is controlled, and her sCr is 1.7 mg/dL. Before initiation of adjuvant chemotherapy, her sCr is 1.8 mg/dL, and her estimated glomerular filtration rate (eGFR) is 28 to 32 mL/minute/1.73m 2 . This severe renal impairment prompts dose reduction of adjuvant chemotherapy.

show abstract

Acute kidney injury is a common and significant complication following ileostomy formation

Cited by 9 publications

References 17 publications

Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure: nationwide population-based study

Defunctioning loop ileostomy in anterior resection for rectal cancer and subsequent renal failure: nationwide population-based study

Major renal morbidity following elective rectal cancer resection by the type of diverting ostomy

Postoperative Acute Kidney Injury in Colorectal Surgery

Contact Info

Product

Resources

About