Deterioration in renal function after stoma creation: a retrospective review from a Middle Eastern tertiary care center

BACKGROUND:
Stomas are associated with multiple complications including dehydration which ultimately affects renal function. These complications begin with changes in the estimated glomerular filtration rate (GFR).


OBJECTIVES:
Evaluate changes in GFR after stoma creation by stoma type and identify how different types of stoma affect GFR.


DESIGN:
Retrospective, analytical cohort


SETTING:
Tertiary care center in Saudi Arabia


PATIENTS AND METHODS:
The colorectal surgery database was reviewed for all adult patients who underwent stoma creation (permanent and temporary ileostomies and colostomies) or reversal in 2000–2015. GFR was estimated at the first encounter, before the index surgery, at the time of stoma reversal, and upon the last follow-up. Patients with renal impairment, including low GFR before stoma creation, patients who had a temporary stoma converted to a permanent stoma, and patients who died with a stoma were excluded. We studied the association of several demographic and clinical factors on changes in GFR by univariate and multivariate analysis.


MAIN OUTCOME MEASURES:
Estimated GFR at the last clinic visit for the permanent stoma group and at stoma closure for the temporary stoma group.


SAMPLE SIZE:
394 patients (149 ileostomates, 245 colostomates)


RESULTS:

Thirty-three (8.4%) of the 394 patients had a low GFR: 11 (7.4%) in the ileostomy group and 22 (9%) in the colostomy group (
P
= .579). The rate of readmissions with ileostomies was higher (11.4%) than with colostomies (3.3%) (
P
≤.001). The number of temporary ileostomies (n=9, 7.0%) differed from temporary colostomies (n=2, 1.9%) but the difference was not statistically significant (
P
=.06). In the multivariate analysis, stoma permanency, hypertension, chemotherapy and nephrotoxic drugs were risk factors associated with low GFR.



CONCLUSION:
Ileostomies were not associated with a high rate of renal function deterioration in comparison to colostomies, but had a significantly higher rate of readmission due to dehydration and electrolytes imbalance possibly due to the hot climate in Saudi Arabia.


LIMITATIONS:
Retrospective nature and limited sample size which may have resulted in a type 2 statistical error.


CONFLICTS OF INTEREST:
None.