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

Alexandra Fielding; Rebecca Woods; Syed R. Moosvi; Richard Q. Wharton; Christopher T. M. Speakman; Sandeep Kapur; Irshad Shaikh; James M. Hernon; Simon W. Lines; Adam T. Stearns

doi:10.1111/codi.14866

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

Alexandra Fielding, Rebecca Woods, Syed R. Moosvi, Richard Q. Wharton, Christopher T. M. Speakman, Sandeep Kapur, Irshad Shaikh, James M. Hernon, Simon W. Lines, Adam T. Stearns

Research output: Contribution to journal › Article › peer-review

51 Citations (Scopus)

15 Downloads (Pure)

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).

Original language	English
Pages (from-to)	269-278
Number of pages	10
Journal	Colorectal Disease
Volume	22
Issue number	3
Early online date	28 Sep 2019
DOIs	https://doi.org/10.1111/codi.14866
Publication status	Published - Mar 2020

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1111/codi.14866

Accepted_ManuscriptAccepted author manuscript, 9.53 MB

Cite this

@article{0c6b11928e2447f0ba891413b775414e,

title = "Renal impairment after ileostomy formation: a frequent event with long term consequences",

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).",

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",

author = "Alexandra Fielding and Rebecca Woods and Moosvi, {Syed R.} and Wharton, {Richard Q.} and Speakman, {Christopher T. M.} and Sandeep Kapur and Irshad Shaikh and Hernon, {James M.} and Lines, {Simon W.} and Stearns, {Adam T.}",

year = "2020",

month = mar,

doi = "10.1111/codi.14866",

language = "English",

volume = "22",

pages = "269--278",

journal = "Colorectal Disease",

issn = "1462-8910",

publisher = "Wiley",

number = "3",

}

TY - JOUR

T1 - Renal impairment after ileostomy formation: a frequent event with long term consequences

AU - Fielding, Alexandra

AU - Woods, Rebecca

AU - Moosvi, Syed R.

AU - Wharton, Richard Q.

AU - Speakman, Christopher T. M.

AU - Kapur, Sandeep

AU - Shaikh, Irshad

AU - Hernon, James M.

AU - Lines, Simon W.

AU - Stearns, Adam T.

PY - 2020/3

Y1 - 2020/3

N2 - 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).

AB - 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).

KW - digestive system

KW - glomerular filtration rate

KW - ileostomy

KW - rectal neoplasms

KW - renal insufficiency

KW - surgical procedures

KW - ANASTOMOTIC LEAKAGE

KW - DEFUNCTIONING STOMA

KW - TOTAL MESORECTAL EXCISION

KW - CKD-EPI EQUATION

KW - GLOMERULAR-FILTRATION-RATE

KW - RECTAL-CANCER

KW - COLORECTAL-CANCER

KW - LOW ANTERIOR RESECTION

KW - CARDIOVASCULAR MORTALITY

KW - CHRONIC KIDNEY-DISEASE

UR - http://www.scopus.com/inward/record.url?scp=85074341048&partnerID=8YFLogxK

U2 - 10.1111/codi.14866

DO - 10.1111/codi.14866

M3 - Article

C2 - 31562789

VL - 22

SP - 269

EP - 278

JO - Colorectal Disease

JF - Colorectal Disease

SN - 1462-8910

IS - 3

ER -

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

Abstract

Keywords

UN SDGs

Access to Document

Other files and links

Cite this