Kidney medicine · 2025
Severe Acute Kidney Injury Associated With Intestinal Ostomies.
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Gómez-Fregoso Juan A, Zaragoza Jose J, González-Duarte Juan Alberto, Nuño-Guzmán Carlos M, Hernández-Barajas Eduardo M, Andrade-Jorge Zarahi, Leon Juarez Correa-de, Padilla-Armas Jorge L, Ornelas-Ruvalcaba Rebeca Lizzete, Cabrera-Aguilar José Said, Chávez-Alonso Gael, Villalvazo-Maciel Estefania, Orozco-Chan Carlos E, Rodríguez-García Gonzalo, Navarro-Blackaller Guillermo, Medina-González Ramón, Gallardo-González Alejandro Martínez, Alcantar-Vallin Luz, Abundis-Mora Gabriela J, García-García Guillermo, Chávez-Iñiguez Jonathan S
Аннотация
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.
EXPOSURES OR PREDICTORS: 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.
STUDY DESIGN: A retrospective cohort study.
SETTING & PARTICIPANTS: Conducted at the Hospital Civil of Guadalajara. We included patients with Ostomy-AKI and General-AKI.
EXPOSURES OR PREDICTORS: 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.