Use of an ACE inhibitor or angiotensin receptor blocker is a major risk factor for dehydration requiring readmission in the setting of a new ileostomy

Abstract

ACEi and ARB use is a significant risk factor for readmission for dehydration following diverting ileostomy creation. Consideration should be given to withholding these medications after ileostomy creation to reduce this risk.

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

“…Studies from North America have reported a similar incidence of unplanned re‐admission following ileostomy formation, with 60‐day re‐admission rates ranging from 16.9% to 36.0% 4,11,22 . Our reported rate of re‐admission with dehydration was slightly lower than those reported by the two studies which utilized the same diagnostic criteria (i.e.…”

“…Previously reported independent predictors for re‐admission with dehydration are diverse. Variables, such as older age, smoking, type 2 diabetes mellitus, ACE inhibitor use, history of ileostomy formation, previous abdominal surgery and creation of an ileal‐pouch‐anal anastomosis were previously found to be significant, although few variables were consistently identified across studies 4,6,9,23 . Variations in diagnostic criteria for dehydration and in the clinical factors selected for inclusion within analyses may have contributed to this inconsistency.…”

“…There have been numerous studies illustrating the high morbidity associated with this procedure, with reported rates of stoma‐related complications ranging from 14% to 66% 1–3 . Unplanned re‐admissions following ileostomy formation are not only common, with the incidence as high as 36% within 60 days of discharge, but are also economically detrimental with the estimated annual healthcare cost of ileostomy‐related re‐admissions reported to be US$94 million in the USA alone 4,5 …”

Ileostomy diarrhea: Pathophysiology and management

“…29 Retrospective analyses also have associated angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (upstream inhibitors of the RAAS system) with an increased risk of dehydration and hospital readmission after ileostomy (odds ratio ¼ 13.56; 95% confidence interval ¼ 3.54-51.92). 30 The effects of mineralocorticoids are likely mediated through direct activation of receptor-mediated electrolyte transport and indirectly mediated through the induction of transcription of adaptive genes. Gene expression maps have been used to compare the ileal tissue of aldosterone-infused rats to that of colectomized rats.…”

Interventions to reduce dehydration related to defunctioning loop ileostomy after low anterior resection in rectal cancer: a prospective cohort study

“…Dehydration ranges from mild, which can be managed in an outpatient setting, to severe, which requires hospital admission and sometimes even treatment in the intensive care unit. Besides, some risk factors have been identified such as previous operation, intake of diuretics, angiotensin‐converting enzyme inhibitor and angiotensin receptor blocker 14,17 . These data raise the question of whether dehydration could be preventable.…”