Ileostomy and Risk of Acute Kidney Injury in Patients With Crohn's Disease

Abstract

BACKGROUND Chron's disease is an inflammatory disorder that can involve any part of GI tract but most commonly involves the small intestine. Many of the patients with Cohn’s disease end up requiring surgery, and the 10-year risk of requiring surgery is estimated to be around 50%. The most common type of surgery in patients with Crohn’s disease is ileocecal resection. More than 40,000 ileostomies are formed annually in the United States. Up to 15% of patients who receive ileostomy experience a de novo or community-onset AKI within 90 days. Oral rehydration with iso-osmolar fluids is the mainstay of outpatient management. Both hypotonic fluids, and hypertonic fluids can cause a net flow of fluid into the bowel lumen increasing the ostomy output. We aimed to study the risk of AKI within 30 days in CD patients after an ileostomy procedure. METHODS We collected data from the Healthcare Cost and Utilization Project- (HCUP) Nationwide Readmission Database- 2016- 2018. CD patients were identified and those who received an ileostomy procedure were identified using ICD-10 and PCS-10 codes respectively. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and the Chi-Square test for Categorical variables. RESULTS We identified 214,622 index hospitalizations with CD, 3,789 of whom received an ileostomy procedure. Of those who received ileostomy, 2.1% were readmitted within 30 days for a primary diagnosis of AKI while 2.9% had 30-day readmission with a secondary diagnosis of AKI. CD patients admitted for AKI after ileostomy had a median length of stay of 14 days (IQR: 8-24). CD patients who received ileostomy had a higher rate of 30-day admission for AKI (2.1% vs. 0.3%, P <0.001) and a higher rate of 30-day readmission with a secondary diagnosis of AKI (2.9% vs. 1.5%, P <0.001) compared to CD patients who didn’t receive ileostomy during the index hospitalization. CD patients who received an ileostomy procedure and were readmitted for AKI within 30 days had an average cost of hospitalization of $140,544 (IQR: $85,072 - $242,059). CD patients admitted for AKI within 30 days after an ileostomy were older (59, IQR: 48-69 vs. 47, IQR: 33-61, P <0.001) compared to those who didn’t have a 30day readmission for AKI respectively. CONCLUSION In a nationwide cohort of patients hospitalized with Crohn’s disease, patients who received ileostomy had a significant risk of AKI within 30-days. The development of AKI was associated with significant morbidity, hospital readmission, and elevated costs of hospitalization. Further studies are needed to investigate novel measures to decrease the risk of AKI in this patient population.