A temporary loop ileostomy affects renal function

Abstract

Purpose

The purpose of this study was to evaluate renal morbidity after a temporary loop ileostomy and to identify possible preoperative risk factors.

Method

Consecutive patients at four hospitals serving 1,520,000 inhabitants who received a temporary loop ileostomy and underwent subsequent closure were identified and retrospectively studied from 1 January 2007 until 28 February 2010. Serum creatinine levels were obtained 1 week before index surgery and 1 week before closure of the loop ileostomy. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula.

Results

Three hundred eight patients with median age of 64 were identified. The indication for the loop ileostomy was colorectal cancer (226), inflammatory bowel disease (41), diverticulosis (8), and other conditions (33). Median time until closure was 161 days (3–873). There was a decrease in eGFR at time of closure (89 vs. 83; p < 0.0001), and the number of patients with renal impairment (eGFR <60) increased (7.5 vs. 21 %, p < 0.0001). Preoperative risk factors for eGFR <60 at closure were age and hypertension.

Conclusions

This study found that a loop ileostomy is associated with a reduced renal function for most patients, especially for older and hypertensive patients. This should be considered before constructing a loop ileostomy, and perhaps another stoma should be chosen if possible in patients at risk. Evaluation of medications before discharge and early and frequent postoperative follow-up could also reduce the risk of a reduced renal function.

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Acknowledgments

The authors would like to express their gratitude to the participating hospitals and to Zoltan Läckberg, MD, Stefan Skullman, MD, PhD, and Gunnar Nylund, MD, PhD.

Conflict of interest

This study is financially supported by the Swedish Society of Medicine, Sahlgrenska University Hospital, Agreement concerning research and education of doctors, ALF, and grants from Anna-Lisa and Bror Björnssons foundation. The authors declare that they have no conflict of interest.

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Correspondence to Bodil Gessler.

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Gessler, B., Haglind, E. & Angenete, E. A temporary loop ileostomy affects renal function. Int J Colorectal Dis 29, 1131–1135 (2014). https://doi.org/10.1007/s00384-014-1949-0

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Keywords

  • Loop ileostomy
  • Morbidity
  • Renal impairment
  • Colorectal/anal neoplasia
  • Benign colorectal disease