New ileostomy formation and subsequent community-onset acute and chronic kidney disease: A population-based cohort study

Abstract

Ileostomy formation results in a loss of colonic absorptive capacity, which may cause volume depletion and kidney disease; however, associations with acute kidney injury (AKI) and chronic kidney disease (CKD) are uncertain. This thesis reports a population-based cohort study that characterizes the relationships between ileostomy formation and subsequent community-onset AKI and CKD. A total of 19,889 patients that underwent surgery in Alberta, Canada between May 2002 and January 2015 were included; 4136 patients that underwent ileostomy formation were compared to 15,753 patients that underwent bowel resection without ileostomy formation. After statistical adjustment using logistic regression, ileostomy formation was associated with subsequent community-onset AKI (OR=4.08; 95% CI=3.62-4.61) and CKD (OR=4.71; 95% CI=3.84-5.77). A series of risk prediction models of these outcomes after ileostomy formation were subsequently developed and evaluated. Clinicians should be vigilant for kidney disease following ileostomy formation and future studies should focus on developing preventative strategies.