Administration of an Oral Hydration Solution Prevents Electrolyte and Fluid Disturbances and Reduces Readmissions in Patients With a Diverting Ileostomy After Colorectal Surgery: A Prospective, Randomized, Controlled Trial

Migdanis, Athanasios; Koukoulis, Georgios; Mamaloudis, Ioannis; Baloyiannis, Ioannis; Migdanis, Ioannis; Kanaki, Maria; Malissiova, Eleni; Tzovaras, Georgios

doi:10.1097/dcr.0000000000001082

Cited by 30 publications

(19 citation statements)

References 17 publications

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“…Risk is not confined to patients with established CKD: differences in renal function even within the bounds of ‘normal’ kidney function influence cardiovascular mortality with a 2.6‐fold increase in patients with eGFR 60–75 ml/min/1.73 m 2 compared to patients with eGFR > 104 ml/min/1.73 m 2 . Strategies such as electrolyte drinks, which have been demonstrated to prevent renal impairment following ileostomy formation, should now be evaluated further to assess impact on short‐term and late renal function .…”

Section: Discussionmentioning

confidence: 99%

“…Impact on renal function has not been considered in recent trials evaluating early ileostomy closure but may be an additional benefit . Careful monitoring of renal function in the postoperative period (particularly in higher risk patients such as older patients and those taking renin–angiotensin system inhibitors) may allow earlier identification of kidney injury and the opportunity to implement intervention such as oral rehydration salts or prioritize early closure.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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 to 2017, with or without a diverting ileostomy. Renal function was calculated preoperatively, before ileostomy closure, and 6 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 Five hundred and eighty‐three 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) vs 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 (1.49–3.46)]. 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).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…The cost associated with each dehydration‐related readmission is estimated as USD 2750 [10]. However, dehydration after ileostomy formation is potentially preventable, with numerous studies successfully demonstrating interventions to reduce dehydration‐related readmission [11–14].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for readmission with dehydration after ileostomy formation: A systematic review and meta‐analysis

et al. 2021

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Aim Ileostomy formation is a commonly performed procedure with substantial associated morbidity. Patients with an ileostomy experience high rates of unplanned hospital readmission with dehydration, and such events have a long‐term health and economic impact. Reports of the significant risk factors associated with these readmissions have been inconsistent. This study aimed to identify the significant risk factors for readmission with dehydration following ileostomy formation. Method A systematic search was conducted using the Medline, Embase, Cochrane and CINAHL databases. All original research articles reporting risk factors for readmission with dehydration following ileostomy formation in adults were included. The primary outcome was the pooled risk ratio of clinically relevant variables potentially associated with dehydration‐related readmission following ileostomy formation. The secondary outcome was the incidence of dehydration‐related readmission. Results Ten studies (27 089 patients) were included. The incidences of 30‐ and 60‐day readmission with dehydration were 5.0% (range 2.1%–13.2%) and 10.3% (range 7.3%–14.1%), respectively. Eight variables were found to be significantly associated with dehydration‐related readmission: age ≥65 years, body mass index ≥30 kg/m2, diabetes mellitus, hypertension, renal comorbidity, regular diuretic use, ileal pouch–anal anastomosis procedure and length of stay after index admission. A preoperative diagnosis of colorectal cancer was less likely to result in readmission with dehydration. Conclusion Readmission with dehydration following ileostomy formation is a significant issue with several risk factors. Awareness of these risk factors will help inform the design of future studies addressing risk prediction, allow risk stratification of ileostomates and aid in the development of personalized prevention strategies.

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“…In a randomized controlled trial in patients after diverting ileostomy, patients receiving 1 L daily of a prophylactic oral rehydration solution had zero dehydration-related readmissions compared to 24% in the control group. 51 The prophylactic group also showed significant improvements in markers of renal function over 40 days of follow-up. Other studies have suggested that oral rehydration solution actually decreases the output; however, this was not seen in the randomized setting.…”

Section: Treatment Of High Ileostomy Output Fluid Repletionmentioning

confidence: 85%

Ileostomy diarrhea: Pathophysiology and management

Rowe

Schiller

2020

Baylor University Medical Center Proceedings

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Ileostomy is a common component of surgical treatments for various gastrointestinal conditions. Loss of the fluid absorptive capacity of the colon results in increased fluid and electrolyte losses, which causes a state of relative fluid depletion. These losses can be offset in part by increased oral intake, but the remaining small intestine also compensates by increasing the efficiency of fluid and electrolyte absorption, a process termed adaptation, which occurs within weeks to months of ileostomy creation. Some patients fail to adapt adequately and have high ileostomy outputs from the time of surgery. Others with a previously well-adapted ileostomy may encounter periods of sustained high output when some additional process causes diarrhea. Many patients experience periods of high output after ileostomy creation and often require hospital readmission for this reason. Any patient with an ileostomy is at great risk of dehydration and electrolyte depletion should output rise dramatically. Prompt attention should be given to rehydration and identification of the underlying cause so that directed therapies may be implemented. This review discusses the alteration of normal intestinal fluid balance from colectomy with ileostomy, proposed mechanisms for adaptation, the differential diagnosis of ileostomy diarrhea, the evaluation of ileostomy diarrhea, and current treatment options.

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Administration of an Oral Hydration Solution Prevents Electrolyte and Fluid Disturbances and Reduces Readmissions in Patients With a Diverting Ileostomy After Colorectal Surgery: A Prospective, Randomized, Controlled Trial

Abstract: An oral isotonic drink postdischarge can have a prophylactic effect on patients with a newly formed ileostomy, preventing readmission for fluid and electrolyte abnormalities. See Video Abstract at http://links.lww.com/DCR/A603.

Cited by 30 publications

References 17 publications

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

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

Risk factors for readmission with dehydration after ileostomy formation: A systematic review and meta‐analysis

Ileostomy diarrhea: Pathophysiology and management

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