Severe Acute Kidney Injury Associated With Intestinal Ostomies

Rationale & Objective

People with ostomies can experience high output, a risk of acute kidney injury (AKI). We evaluated patients with AKI associated with ostomies (ostomy-AKI) and compared with AKI of other etiologies (general-AKI) with the objective of describing their clinical presentation and their association with major adverse kidney events at 10 and 30-90 days (major adverse kidney events [MAKE] 10 and 30-90, respectively).

Study Design

A retrospective cohort study.

Setting & Participants

Conducted at the Hospital Civil of Guadalajara. We included patients with Ostomy-AKI and General-AKI.

Exposure(s) or Predictor(s)

Ostomy-AKI.

Outcomes

Describing and differentiating their clinical presentation and their association with MAKE 10 and MAKE 30-90, in addition to its individual components, as death, new requirement for dialysis, or ≥25% decline in the estimated glomerular filtration rate from baseline.

Analytical Approach

Analyzed the risk by logistic regression model and a multivariate Cox proportional hazard.

Results

From February 2020 to October 2023, 84 patients with ostomy-AKI and 348 with general-AKI were included. Most ostomy-AKI were male (78.7 vs 56.2%), the mean ostomy output was 980 mL/day (760-1,700), 82.9% requiring fluid adjustment. Ostomies had been created for cancer (46%) 2.3 months before AKI. The etiology of ostomy-AKI, compare to general-AKI, was more frequently due to hypovolemia (48.9% vs 24.5%) and was of greater AKI severity (stage 3, 82.9% vs 63.9%). Both groups had the same frequency of MAKE 10 (94%), and their individual components. MAKE 30-90 occurred more frequently in ostomy-AKI (65.9% vs 49.3%) as well as mortality (59.5% vs 37%), doubling this risk (OR 2.403; 95% CI, 1.090-5.299; P = 0.03 and OR 2.757; 95% CI, 1.273-5.973; P = 0.01, respectively).

Limitations

A retrospective cohort, residual confounding, and small sample size.

Conclusions

In comparison with general-AKI, patients with ostomy-AKI present more often with hypovolemia and greater AKI stage, had a higher mortality at 30-90 day follow-up, and a 2.5-fold increase in risk of MAKE.

Plain-Language Summary

Hypovolemia is a frequently observed in patients with high output ostomy. In such cases, the risk of developing acute kidney injury (AKI) is elevated. This complication is strongly related to adverse clinical outcomes. However, the major adverse kidney events during mid-term follow-up have not been adequately explored. In this cohort of patients with AKI, we observed that those with ostomy-related AKI, compared with those without ostomy presented more frequent with hypovolemia attributed to a high output stoma and more severe AKI stages. The risk of major adverse kidney events at 30-90 days was significantly higher, particularly in terms of mortality.