Long-term impact of diverting ileostomy after stoma closure on the renal function and risk factors for chronic kidney disease following colorectal tumor surgery.

PURPOSE: Long-term renal outcomes after ileostomy closure in patients undergoing curative colorectal tumor resection and diverting ileostomy remain unclear. We investigated renal outcomes and risk factors for chronic kidney disease (CKD) in this population.

METHODS

Patients who underwent colorectal tumor surgery after diverting ileostomy between January 2013 and December 2020 were analyzed. The serum creatinine (sCr) level and estimated glomerular filtration rate (eGFR) were monitored for up to three years after stoma closure. CKD progression was defined as an eGFR < 60 mL/min/1.73 m2. A multivariate analysis was used to identify independent risk factors for CKD.

RESULTS

In total, 533 patients were included: 112 with preoperative CKD and 421 without CKD. Among patients without preoperative CKD, 322 were followed up for 3 years after stoma closure. sCr levels and the eGFR showed persistent worsening even after stoma closure. Based on the eGFR at three years, patients were grouped into CKD and non-CKD groups. A multivariate analysis revealed that age ≥ 70 years old, a preoperative eGFR < 90 mL/min/1.73 m2, and ileostomy-associated kidney injury were independent risk factors for CKD after stoma closure. The sCr levels and eGFR worsened up to three years after stoma closure, even without these risk factors.

CONCLUSIONS

Diverting ileostomy poses a risk of a renal function decline even after stoma closure.