Ileostomy creation in colorectal cancer surgery: risk of acute kidney injury and chronic kidney disease

Linda Li, Kelsey S. Lau, Venkat Ramanathan, Sonia T. Orcutt, Shubhada Sansgiry, Daniel Albo, David H. Berger, Daniel A. Anaya

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Ileostomy creation is associated with postoperative dehydration and readmission; however, the effect on renal function is unknown. Our goal was to characterize the impact of ileostomy creation on acute and chronic renal function. Materials and methods A retrospective cohort study with patients undergoing colorectal cancer surgery at a tertiary referral institution (2005-2011). The relationship between ileostomy creation and acute kidney injury (AKI)-related readmission, severe chronic kidney disease (CKD) at 12 mo (glomerular filtration rate <30 mL/min/1.73 m2), and onset of severe CKD over time was evaluated using multivariable logistic and Cox regression and adjusted using propensity score stratification. Results Among 619 patients, 84 (13%) had ileostomy. AKI-related readmission and severe CKD at 12 mo were more common among ileostomy patients (17% versus 2%, P < 0.01 and 13.3% versus 5%, P = 0.02, respectively). After propensity score adjustment, ileostomy was a significant predictor of AKI-related readmissions (odds ratio: 10.3; 95% confidence interval [CI], 3.9-27.2), severe CKD at 12 mo (odds ratio: 4.1; 95% CI, 1.4-11.9), and onset of severe CKD over time (hazard ratio: 4.2; 95% CI, 2.3-6.6). Conclusions Ileostomy creation is associated with increased risk of AKI-related readmissions and development of severe CKD. Future studies must focus on strategies to minimize kidney injury when ileostomy is a necessary component of colorectal cancer surgery and revisiting current indications for ileostomy creation.

Original languageEnglish (US)
Pages (from-to)204-212
Number of pages9
JournalJournal of Surgical Research
Volume210
DOIs
StatePublished - Apr 1 2017

Fingerprint

Ileostomy
Colorectal Surgery
Chronic Renal Insufficiency
Acute Kidney Injury
Colorectal Neoplasms
Propensity Score
Confidence Intervals
Kidney
Odds Ratio
Glomerular Filtration Rate
Dehydration
Cohort Studies
Referral and Consultation
Retrospective Studies
Logistic Models

Keywords

  • Acute kidney injury
  • Chronic renal insufficiency
  • Colorectal neoplasms
  • Ileostomy
  • Patient readmission

ASJC Scopus subject areas

  • Surgery

Cite this

Ileostomy creation in colorectal cancer surgery : risk of acute kidney injury and chronic kidney disease. / Li, Linda; Lau, Kelsey S.; Ramanathan, Venkat; Orcutt, Sonia T.; Sansgiry, Shubhada; Albo, Daniel; Berger, David H.; Anaya, Daniel A.

In: Journal of Surgical Research, Vol. 210, 01.04.2017, p. 204-212.

Research output: Contribution to journalArticle

Li, Linda ; Lau, Kelsey S. ; Ramanathan, Venkat ; Orcutt, Sonia T. ; Sansgiry, Shubhada ; Albo, Daniel ; Berger, David H. ; Anaya, Daniel A. / Ileostomy creation in colorectal cancer surgery : risk of acute kidney injury and chronic kidney disease. In: Journal of Surgical Research. 2017 ; Vol. 210. pp. 204-212.
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abstract = "Background Ileostomy creation is associated with postoperative dehydration and readmission; however, the effect on renal function is unknown. Our goal was to characterize the impact of ileostomy creation on acute and chronic renal function. Materials and methods A retrospective cohort study with patients undergoing colorectal cancer surgery at a tertiary referral institution (2005-2011). The relationship between ileostomy creation and acute kidney injury (AKI)-related readmission, severe chronic kidney disease (CKD) at 12 mo (glomerular filtration rate <30 mL/min/1.73 m2), and onset of severe CKD over time was evaluated using multivariable logistic and Cox regression and adjusted using propensity score stratification. Results Among 619 patients, 84 (13{\%}) had ileostomy. AKI-related readmission and severe CKD at 12 mo were more common among ileostomy patients (17{\%} versus 2{\%}, P < 0.01 and 13.3{\%} versus 5{\%}, P = 0.02, respectively). After propensity score adjustment, ileostomy was a significant predictor of AKI-related readmissions (odds ratio: 10.3; 95{\%} confidence interval [CI], 3.9-27.2), severe CKD at 12 mo (odds ratio: 4.1; 95{\%} CI, 1.4-11.9), and onset of severe CKD over time (hazard ratio: 4.2; 95{\%} CI, 2.3-6.6). Conclusions Ileostomy creation is associated with increased risk of AKI-related readmissions and development of severe CKD. Future studies must focus on strategies to minimize kidney injury when ileostomy is a necessary component of colorectal cancer surgery and revisiting current indications for ileostomy creation.",
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AU - Li, Linda

AU - Lau, Kelsey S.

AU - Ramanathan, Venkat

AU - Orcutt, Sonia T.

AU - Sansgiry, Shubhada

AU - Albo, Daniel

AU - Berger, David H.

AU - Anaya, Daniel A.

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N2 - Background Ileostomy creation is associated with postoperative dehydration and readmission; however, the effect on renal function is unknown. Our goal was to characterize the impact of ileostomy creation on acute and chronic renal function. Materials and methods A retrospective cohort study with patients undergoing colorectal cancer surgery at a tertiary referral institution (2005-2011). The relationship between ileostomy creation and acute kidney injury (AKI)-related readmission, severe chronic kidney disease (CKD) at 12 mo (glomerular filtration rate <30 mL/min/1.73 m2), and onset of severe CKD over time was evaluated using multivariable logistic and Cox regression and adjusted using propensity score stratification. Results Among 619 patients, 84 (13%) had ileostomy. AKI-related readmission and severe CKD at 12 mo were more common among ileostomy patients (17% versus 2%, P < 0.01 and 13.3% versus 5%, P = 0.02, respectively). After propensity score adjustment, ileostomy was a significant predictor of AKI-related readmissions (odds ratio: 10.3; 95% confidence interval [CI], 3.9-27.2), severe CKD at 12 mo (odds ratio: 4.1; 95% CI, 1.4-11.9), and onset of severe CKD over time (hazard ratio: 4.2; 95% CI, 2.3-6.6). Conclusions Ileostomy creation is associated with increased risk of AKI-related readmissions and development of severe CKD. Future studies must focus on strategies to minimize kidney injury when ileostomy is a necessary component of colorectal cancer surgery and revisiting current indications for ileostomy creation.

AB - Background Ileostomy creation is associated with postoperative dehydration and readmission; however, the effect on renal function is unknown. Our goal was to characterize the impact of ileostomy creation on acute and chronic renal function. Materials and methods A retrospective cohort study with patients undergoing colorectal cancer surgery at a tertiary referral institution (2005-2011). The relationship between ileostomy creation and acute kidney injury (AKI)-related readmission, severe chronic kidney disease (CKD) at 12 mo (glomerular filtration rate <30 mL/min/1.73 m2), and onset of severe CKD over time was evaluated using multivariable logistic and Cox regression and adjusted using propensity score stratification. Results Among 619 patients, 84 (13%) had ileostomy. AKI-related readmission and severe CKD at 12 mo were more common among ileostomy patients (17% versus 2%, P < 0.01 and 13.3% versus 5%, P = 0.02, respectively). After propensity score adjustment, ileostomy was a significant predictor of AKI-related readmissions (odds ratio: 10.3; 95% confidence interval [CI], 3.9-27.2), severe CKD at 12 mo (odds ratio: 4.1; 95% CI, 1.4-11.9), and onset of severe CKD over time (hazard ratio: 4.2; 95% CI, 2.3-6.6). Conclusions Ileostomy creation is associated with increased risk of AKI-related readmissions and development of severe CKD. Future studies must focus on strategies to minimize kidney injury when ileostomy is a necessary component of colorectal cancer surgery and revisiting current indications for ileostomy creation.

KW - Acute kidney injury

KW - Chronic renal insufficiency

KW - Colorectal neoplasms

KW - Ileostomy

KW - Patient readmission

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