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Variations of the renal function parameters in rectal cancer patients with a defunctioning loop ileostomy

  • Nephrology - Original Paper
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Abstract

Purpose

The objective of this study is to investigate the impact of the temporary loop ileostomy on renal function and also to assess the factors associated with the change in renal function observed between the index surgery (the moment of the radical surgical procedure) and the closure of the ileostomy (the moment of the secondary surgical act of suppression of the ileostomy).

Methods

A total of 69 rectal cancer patients from a single referral surgical unit who had a loop ileostomy during low anterior resection of the rectum were included in this study. Serum creatinine levels were evaluated, and estimated glomerular filtration rate (eGFR) was calculated prior to index surgery and closure of the ileostomy.

Results

During this time interval, there was a significant decrease in eGFR levels (mean difference − 4.5 mL/min/1.73 m2, 95% CI − 7.8 to − 1.3 mL/min/1.73 m2), and also a significant increase in the serum creatinine values (mean difference 0.07, 95% CI 0.02–0.12 mg/dL). The eGFR decrease was more pronounced in diabetic patients, in those with a baseline Charlson Comorbidity Index score ≥ 1 or in those that received chemotherapy. In a multivariable regression analysis, the use of neoadjuvant chemotherapy was the only variable significantly associated with the change in eGFR levels between the two surgical interventions.

Conclusion

Renal function impairment is an important event that the surgeon has to take into consideration when deciding upon opting for a loop ileostomy to temporarily defunction a colorectal anastomosis.

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Abbreviations

CCI:

Charlson Comorbidity Index

cT3/4:

Clinical tumor staging—stage 3 or 4

cN+:

Clinical lymph node staging—positive lymph nodes

DID:

Difference in difference

eGFR:

Estimated glomerular filtration rate

IQR:

Inter-quartile range

SD:

Standard deviation

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Correspondence to Dragos Viorel Scripcariu.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This study was approved by the ethics boards of the Regional Institute of Oncology and the University of Medicine and Pharmacy “Grigore T Popa” Iasi. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patients had given their written consent for clinical data to be used in scientific purposes.

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Scripcariu, D.V., Siriopol, D., Moscalu, M. et al. Variations of the renal function parameters in rectal cancer patients with a defunctioning loop ileostomy. Int Urol Nephrol 50, 1489–1495 (2018). https://doi.org/10.1007/s11255-018-1927-5

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  • DOI: https://doi.org/10.1007/s11255-018-1927-5

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