Amputations and foot‐related hospitalisations disproportionately affect dialysis patients

Lavery, Lawrence A.; Lavery, David C.; Hunt, Nathan A.; Fontaine, Javier La; Ndip, Agbor; Boulton, Andrew J.M.

doi:10.1111/iwj.12146

Cited by 61 publications

(43 citation statements)

References 15 publications

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“…For example, Aboriginal and Torres Strait Islander people have higher prevalence of type 2 diabetes, circulatory disease and end stage renal disease compared to other Australians [31] and there are known associations between these conditions and the risk of ulceration and subsequent amputation[32,33]. …”

Section: Discussionmentioning

confidence: 99%

Geographic Variation of the Incidence Rate of Lower Limb Amputation in Australia from 2007-12

et al. 2017

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In Australia, little is known about how the incidence rate (IR) of lower limb amputation (LLA) varies across the country. While studies in other economically developed countries have shown considerable geographic variation in the IR-LLA, mostly these have not considered whether the effect of common risk factors are the same across regions. Mapping variation of the IR-LLA, and the effect of common risk factors, is an important first step to focus research into areas of greatest need and support the development of regional specific hypotheses for in-depth examination. The aim of this study was to describe the geographic variation in the IR-LLA across Australia and understand whether the effect of common risk factors was the same across regions. Using hospital episode data from the Australian National Hospital Morbidity database and Australian Bureau of Statistics, the all-cause crude and age-standardised IR-LLA in males and females were calculated for the nation and each state and territory. Generalised Linear Models were developed to understand which factors influenced geographic variation in the crude IR-LLA. While the crude and age-standardised IR-LLA in males and females were similar in most states and territories, they were higher in the Northern Territory. The effect of older age, being male and the presence of type 2 diabetes was associated with an increase of IR-LLA in most states and territories. In the Northern Territory, the younger age at amputation confounded the effect of sex and type 2 diabetes. There are likely to be many factors not included in this investigation, such as Indigenous status, that may explain part of the variation in the IR-LLA not captured in our models. Further research is needed to identify regional- and population- specific factors that could be modified to reduce the IR-LLA in all states and territories of Australia.

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Section: Discussionmentioning

confidence: 99%

Geographic Variation of the Incidence Rate of Lower Limb Amputation in Australia from 2007-12

et al. 2017

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“…Adults with chronic kidney disease (CKD), particularly those with end-stage renal disease (ESRD) requiring dialysis, have an increased risk of foot ulceration and lower extremity amputation [ 1 – 5 ]. As a result, dialysis patients have high rates of foot-related hospital admissions [ 6 ]. This is a serious problem due to the morbidity associated with ulceration and amputation, and the increased risk of mortality once a patient has an ulcer or amputation [ 1 , 7 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study

et al. 2017

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BackgroundAdults on dialysis are at increased risk of foot ulceration, which commonly precedes more serious lower limb complications, including amputation. Limited data exist regarding the prevalence and factors associated with foot disease in this population. Hence, this study set out to investigate factors associated with foot ulceration and amputation in a dialysis cohort.MethodsThis study presents a cross-sectional analysis of baseline data from a multi-center prospective cohort study. We recruited 450 adults with end-stage renal disease on dialysis from multiple satellite and home-therapy dialysis units in Melbourne, Australia from January to December 2014. Data collection consisted of a participant interview, medical record review, health-status questionnaire and non-invasive foot examination. Logistic regression analyses were conducted to evaluate associations between screened variables and study outcomes.ResultsMean age was 67.5 (SD, 13.2) years, 64.7% were male, 94% were on hemodialysis, median dialysis duration was 36.9 (IQR, 16.6 to 70.1) months, and 50.2% had diabetes. There was a high prevalence of previous ulceration (21.6%) and amputation (10.2%), 10% had current foot ulceration, and 50% had neuropathy and/or peripheral arterial disease. Factors associated with foot ulceration were previous amputation (OR, 10.19), peripheral arterial disease (OR, 6.16) and serum albumin (OR, 0.87); whereas previous and/or current ulceration (OR, 167.24 and 7.49, respectively) and foot deformity (OR, 15.28) were associated with amputation.ConclusionsDialysis patients have a high burden of lower limb complications. There are markedly higher risks of foot ulceration and/or amputation in those with previous and/or current ulceration, previous amputation, peripheral arterial disease, lower serum albumin, and foot deformity. Although not a major risk factor, diabetes in men was an important effect modifier for risk of ulceration.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0711-6) contains supplementary material, which is available to authorized users.

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“…The dialysis group with 150 patients with diabetes had higher rates of foot ulcerations and amputations, with estimated cumulative incidence rates of 210 and 58 per 1000 person-years, respectively, when compared with 150 patients with diabetes with a history of foot ulceration. 5 …”

Section: Introductionmentioning

confidence: 99%

Implementation of routine foot check in patients with diabetes on hemodialysis: associations with outcomes

Pernat

Peršič

Usvyat

et al. 2016

BMJ Open Diab Res Care

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ObjectivePatients with diabetes are at increased risk of foot ulcers, which may result in limb amputations. While regular foot care prevents ulcerations and amputation in those patients with diabetes not on dialysis, evidence is limited in diabetic hemodialysis patients. We investigated the association between the implementation of a routine foot check program in diabetic incident hemodialysis patients, and major lower limb amputations.MethodsIn 1/2008, monthly intradialytic foot checks were implemented as part of standard clinic care in all Fresenius Medical Care North America hemodialysis facilities. Patients with diabetes who initiated hemodialysis between 1/2004 and 12/2007 constituted the preimplementation cohort, and patients starting hemodialysis between 1/2008 and 12/2011 comprised the postimplementation cohort. In addition, we conducted a sensitivity analysis where we excluded patients from the clinics with <10 patients in the postimplementation period and where percent difference in patient with diabetes number between postimplementation and preimplementation period was <20%. We compared lower limb amputation rates employing Poisson regression models with offset of exposure time in these two cohorts.ResultsWe studied 35 513 patients in the preimplementation and 25 779 patients in the postimplementation cohort. In the postimplementation cohort, amputation rate decreased by 17% (p=0.0034). The major lower limb amputation rate was 1.30 per 100 patient years in preimplementation and 1.07 in postimplementation cohort. These beneficial results were corroborated in the multivariate analysis (p=0.0175) and were even more pronounced in the sensitivity analysis (p=0.0083).ConclusionMonthly foot checks are associated with reduction of major lower limb amputations in diabetic incident hemodialysis patients.

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Amputations and foot‐related hospitalisations disproportionately affect dialysis patients

Cited by 61 publications

References 15 publications

Geographic Variation of the Incidence Rate of Lower Limb Amputation in Australia from 2007-12

Geographic Variation of the Incidence Rate of Lower Limb Amputation in Australia from 2007-12

Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study

Implementation of routine foot check in patients with diabetes on hemodialysis: associations with outcomes

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