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Severe Acute Kidney Injury Associated With Intestinal Ostomies
Juan A Gómez-Fregoso1,2, Jose J Zaragoza3, Juan Alberto González-Duarte2,4
1Nephrology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco. Mexico.
Kidney Medicine
|October 6, 2025
Summary
Patients with ostomy-associated acute kidney injury (AKI) often have hypovolemia and severe AKI. They face increased mortality and major adverse kidney events (MAKE) within 30-90 days compared to other AKI causes.
Area of Science:
- Nephrology
- Urology
- Gastroenterology
Background:
- High output from ostomies poses a risk for acute kidney injury (AKI).
- Understanding the clinical presentation and outcomes of ostomy-AKI is crucial for patient management.
Purpose of the Study:
- To evaluate patients with ostomy-AKI, comparing their clinical presentation and outcomes to general-AKI.
- To assess the association of ostomy-AKI with major adverse kidney events (MAKE) at 10 and 30-90 days.
Main Methods:
- Retrospective cohort study including patients with ostomy-AKI and general-AKI.
- Clinical presentation, AKI severity, and MAKE components (death, dialysis, GFR decline) were analyzed.
- Logistic regression and multivariate Cox proportional hazard models were used to assess risk.
Main Results:
- 84 ostomy-AKI and 348 general-AKI patients were included.
- Ostomy-AKI patients more frequently presented with hypovolemia (48.9% vs 24.5%) and higher AKI severity (Stage 3: 82.9% vs 63.9%).
- MAKE 30-90 (65.9% vs 49.3%) and mortality (59.5% vs 37%) were significantly higher in ostomy-AKI patients.
Conclusions:
- Ostomy-AKI is often linked to hypovolemia and severe kidney injury.
- Patients with ostomy-AKI experience higher long-term mortality and increased risk of major adverse kidney events.
- Early recognition and fluid management are critical for patients with high-output ostomies to prevent severe kidney outcomes.
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