Skip to main content
SpringerLink
Log in

Early renal dysfunction after temporary ileostomy construction

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Loop ileostomy is often used to prevent complications after colorectal surgery, but it has been reported to cause renal impairment. This study aimed to evaluate the changes in the renal function after ileostomy and to compare these with the renal function after low anterior resection without ileostomy (low-ANT).

Methods

The subjects included 58 patients who underwent ileostomy construction and closure for rectal cancer. The estimated glomerular filtration rate (eGFR) was calculated at specific time points after the index surgery. In addition, we conducted a case-matched study on 147 patients who underwent low-ANT.

Results

The eGFR was significantly lower at 1 month after ileostomy than at the time of ileostomy construction (78.8 vs. 84.0, p < 0.0001) and did not improve after ileostomy closure. The only risk factor for a reduced eGFR was preoperative chemotherapy or chemoradiotherapy. In the case-matched study, 36 patients were allocated for each of the two groups. The number of ileostomy patients with a reduced eGFR was significantly increased 1 month after the index surgery (p = 0.005).

Conclusions

The eGFR began to decrease at one month after ileostomy construction and did not improve after ileostomy closure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253:890–9.

    Article  Google Scholar 

  2. Ashburn JH, Stocchi L, Kiran RP, Dietz DW, Remzi FH. Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon Rectum. 2013;56:275–80.

    Article  Google Scholar 

  3. Shinji S, Ueda Y, Yamada T, Koizumi M, Yokoyama Y, Takahashi G, et al. Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer. BMC Gastroenterol. 2018;18:117.

    Article  Google Scholar 

  4. Vasiliu EC, Zarnescu NO, Costea R, Neagu S. Review of risk factors for anastomotic leakage in colorectal surgery. Chirurgia (Bucur). 2015;110:319–26.

    Google Scholar 

  5. Yoshioka Y, Uehara K, Ebata T, Yokoyama Y, Mitsuma A, Ando Y, et al. Postoperative complications following neoadjuvant bevacizumab treatment for advanced colorectal cancer. Surg Today. 2014;44:1300–6.

    Article  Google Scholar 

  6. Marusch F, Koch A, Schmidt U, Geibetaler S, Dralle H, Saeger HD, et al. Value of a protective stoma in low anterior resections for rectal cancer. Dis Colon Rectum. 2002;45:1164–71.

    Article  Google Scholar 

  7. Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg. 2005;92:1137–42.

    Article  CAS  Google Scholar 

  8. Yao H, An Y, Zhang Z. The application of defunctioning stomas after low anterior resection of rectal cancer. Surg Today. 2019;49:451–9.

    Article  Google Scholar 

  9. Rondelli F, Reboldi P, Rulli A, Barberini F, Guerrisi A, Izzo L, et al. Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis: a meta-analysis. Int J Colorectal Dis. 2009;24:479–88.

    Article  CAS  Google Scholar 

  10. Tilney HS, Sains PS, Lovegrove RE, Reese GE, Heriot AG, Tekkis PP. Comparison of outcomes following ileostomy versus colostomy for defunctioning colorectal anastomoses. World J Surg. 2007;31:1142–51.

    Article  Google Scholar 

  11. Shabbir J, Britton DC. Stoma complications: a literature overview. Colorectal Dis. 2010;12:958–64.

    Article  CAS  Google Scholar 

  12. Messaris E, Sehgal R, Deiling S, Koltun WA, Stewart D, McKenna K, et al. Dehydration is the most common indication for readmission after diverting ileostomy creation. Dis Colon Rectum. 2012;55:175–80.

    Article  Google Scholar 

  13. Paquette IM, Solan P, Rafferty JF, Ferguson MA, Davis BR. Readmission for dehydration or renal failure after ileostomy creation. Dis Colon Rectum. 2013;56:974–9.

    Article  Google Scholar 

  14. Beck-Kaltenbach N, Voigt K, Rumstadt B. Renal impairment caused by temporary loop ileostomy. Int J Colorectal Dis. 2011;26:623–6.

    Article  Google Scholar 

  15. Gessler B, Haglind E, Angenete E. A temporary loop ileostomy affects renal function. Int J Colorectal Dis. 2014;29:1131–5.

    Article  Google Scholar 

  16. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–70.

    Article  CAS  Google Scholar 

  17. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    Article  Google Scholar 

  18. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53:982–92.

    Article  CAS  Google Scholar 

  19. Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10–year population-based study of the effects of gender and age. Kidney Int. 2006;69:375–82.

    Article  CAS  Google Scholar 

  20. Lindeman RD, Tobin J, Shock NW. Longitudinal studies on the rate of decline in renal function with age. J Am Geriatr Soc. 1985;33:278–85.

    Article  CAS  Google Scholar 

  21. Imai E, Horio M, Yamagata K, Iseki K, Hara S, Ura N, et al. Slower decline of glomerular filtration rate in the Japanese general population: a longitudinal 10–year follow-up study. Hypertens Res. 2008;31:433–41.

    Article  Google Scholar 

  22. Scripcariu DV, Siriopol D, Moscalu M, Scripcariu V. Variations of the renal function parameters in rectal cancer patients with a defunctioning loop ileostomy. Int Urol Nephrol. 2018;50:1489–95.

    Article  Google Scholar 

  23. Takeda M, Takahashi H, Haraguchi N, Miyoshi N, Hata T, Yamamoto H, et al. Factors predictive of high-output ileostomy: a retrospective single-center comparative study. Surg Today. 2019;49:482–7.

    Article  CAS  Google Scholar 

  24. Danielsen AK, Park J, Jansen JE, Bock D, Skullman S, Wedin A, et al. Early closure of a temporary ileostomy in patients with rectal cancer: a multicenter randomized controlled trial. Ann Surg. 2017;265:284–90.

    Article  Google Scholar 

  25. Farag S, Rehman S, Sains P, Baig MK, Sajid MS. Early vs. delayed closure of loop defunctioning ileostomy in patients undergoing distal colorectal resections: an integrated systematic review and meta-analysis of published randomized controlled trials. Colorectal Dis. 2017;19:1050–7.

    Article  CAS  Google Scholar 

  26. Alves A, Panis Y, Lelong B, Dousset B, Benoist S, Vicaut E. Randomized clinical trial of early versus delayed temporary stoma closure after proctectomy. Br J Surg. 2008;95:693–8.

    Article  CAS  Google Scholar 

  27. Migdanis A, Koukoulis G, Mamaloudis I, Baloyiannis I, Migdanis I, Kanaki M, et al. 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. Dis Colon Rectum. 2018;61:840–6.

    Article  Google Scholar 

  28. Kim S, Jung SH, Kim JH. Ileostomy versus fecal diversion device to protect anastomosis after rectal surgery: a randomized clinical trial. Int J Colorectal Dis. 2019;34:811–9.

    Article  Google Scholar 

  29. Hayden DM, Pinzon MC, Francescatti AB, Edquist SC, Malczewski MR, Jolley JM, et al. Hospital readmission for fluid and electrolyte abnormalities following ileostomy construction: preventable or unpredictable? J Gastrointest Surg. 2013;17:298–303.

    Article  Google Scholar 

  30. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    Article  CAS  Google Scholar 

  31. Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension. 2003;42:1050–65.

    Article  CAS  Google Scholar 

  32. Chen DP, Davis BR, Simpson LM, Cushman WC, Cutler JA, Dobre M, et al. Association between chronic kidney disease and cancer mortality: a report from the ALLHAT. Clin Nephrol. 2017;87:11–20.

    Article  Google Scholar 

  33. Na SY, Sung JY, Chang JH, Kim S, Lee HH, Park YH, et al. Chronic kidney disease in cancer patients: an independent predictor of cancer-specific mortality. Am J Nephrol. 2011;33:121–30.

    Article  Google Scholar 

  34. Weng PH, Hung KY, Huang HL, Chen JH, Sung PK, Huang KC. Cancer-specific mortality in chronic kidney disease: longitudinal follow-up of a large cohort. Clin J Am Soc Nephrol. 2011;6:1121–8.

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all of the members of the IMU School of Medicine for their excellent assistance and Enago (www.enago.jp) for the English language review.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Iwate Medical University School of Medicine, 2-1-1 Idai-dori Yahaba, Shiwa, Iwate, 028-3695, Japan

    Mizunori Yaegashi, Koki Otsuka, Toshimoto Kimura, Teppei Matsuo, Hitoshi Fujii, Kei Sato, Kiyoharu Takashimizu, Tomoki Hatanaka & Akira Sasaki

  2. Department of Surgery, Iwate Prefectural Kuji Hospital, 10-1 Asahimati, Kuji, Iwate, 028-0014, Japan

    Mizunori Yaegashi, Toru Yoshida & Chihiro Tono

Authors
  1. Mizunori Yaegashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Koki Otsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshimoto Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Teppei Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hitoshi Fujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kei Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kiyoharu Takashimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tomoki Hatanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Toru Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Chihiro Tono
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Akira Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mizunori Yaegashi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was approved by the institutional review board of Iwate Medical University (IMU).

Research involving human and animal participants

This study was an observational study with no intervention.

Informed consent

All patients provided their informed consent before the surgery. According to the institutional review board of IMU and based on the retrospective design of this study, we informed the public regarding the research program.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yaegashi, M., Otsuka, K., Kimura, T. et al. Early renal dysfunction after temporary ileostomy construction. Surg Today 50, 703–710 (2020). https://doi.org/10.1007/s00595-019-01938-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-019-01938-y

Keywords

Search

Navigation