Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

Abstract

Among the spectrum of risk for diabetic foot disease conferred by chronic kidney disease (CKD), end-stage renal disease (ESRD) has emerged as a novel independent risk factor. Apart from the classical triad of neuropathy, infection, and peripheral arterial disease that operate in these individuals, the risk is further compounded by inadequate foot self-care by patients and by dialysis centers not providing onsite foot care, as medical priorities are diverted to the dialysis itself. Consequently, the burden of diabetic foot disease has increased in the CKD and ESRD population as exemplified by high ulceration, amputation, and foot-related mortality rates. Current guidelines on foot care in diabetes should recognize advanced CKD and ESRD/dialysis as a separate risk factor for foot disease to alert professionals and highlight the opportunity for prevention. Recent studies have demonstrated improved foot outcomes when chiropody programs are instituted within dialysis units.

Lower Extremity Amputation and Mortality Rates in the Reconstructed Diabetic Charcot Foot and Ankle With External Fixation

“…While 10.35% (12 patients) had ESRD requiring hemodialysis in our study, this had no statistical significance for lower extremity amputation or mortality. This finding differs from the current literature which shows generally poorer outcomes with both amputation and mortality in patients with renal disease 18 and this difference may be accounted for by individualized patient characteristics and surgical selection criteria based on the complexity of CN in patients with more advanced renal disease.…”

Endovascular Treatment for Infrainguinal Vessels in Patients With Critical Limb Ischemia

“…The results of this study were generally in agreement with those of previous reports. [23][24][25][26] TASC II recommends that factors that can negatively affect wound healing, such as cardiac failure or poor nutritional status, should be evaluated and treated appropriately.…”

“…As chronic kidney disease progresses, the results also worsen and outcomes for patients on dialysis are very poor. 25,26,[28][29][30] A metaanalysis of the results of revascularization using venous grafts revealed that the 5-year amputation-free rate for the lower limb was 67% and the survival rate was 25% in patients on dialysis. 31 Dialysis also was the most important risk factor in our study population.…”

Patency of Reverse Saphenous Vein Graft for Revascularization of Lower Limbs in Diabetic Patients

“…The risk factors may negatively influence the decision to perform a revascularization procedure [22]. However, our data indicate that even patients with increased risk factors may have favorable results [23]. Our study further establishes the advantages of early revascularization in diabetic patients who have critical limb ischemia requiring revascularization.…”