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 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).

The feasibility and safety of early ileostomy reversal: a systematic review and meta‐analysis

“…The long‐term impact of a temporary ileostomy should not be underestimated. A recent study showed that ileostomy formation is independently associated with kidney injury and that this persists with long‐term follow‐up 38,39 …”

Re‐admissions after ileostomy formation: a retrospective analysis from a New Zealand tertiary centre

“…Dehydration has been cited as the most common reason for re‐admission accounting for 40–62% of all re‐admissions 6,7 . Short‐term renal impairment following ileostomy formation is shown to impart long‐term consequences, with patients suffering higher risk of moderate to severe chronic kidney disease up to 1 year after the index operation 8 . Dehydration‐related re‐admissions are expensive, estimated at US$2750 and US$9107 per re‐admission for dehydration and renal failure, respectively 9 …”

Assessment of the risk of permanent stoma after low anterior resection in rectal cancer patients

“…In addition, given the possible complications associated with the presence of ileostomy, such as electrolyte disturbances, renal dysfunction, and the risk of surgical complications associated with the ileostomy itself and ileostomy closure procedures, it is necessary to define the group of patients who actually benefit from elective diversion [ 4 – 6 ]. The rate of non-closure of the stoma is difficult to compare due to different criteria adopted by authors, including different latest expected time to closure which ranges from 9 to 36 months.…”