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

Kaminski, Michelle; Raspovic, Anita; McMahon, Lawrence P.; Lambert, Katrina A.; Erbas, Bircan; Mount, Peter F.; Kerr, Peter G.; Landorf, Karl B

doi:10.1186/s12882-017-0711-6

Cited by 42 publications

(57 citation statements)

References 52 publications

(63 reference statements)

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“…Mortality risk for PAD patients with CKD is 2–4 times higher than PAD patients without CKD 6–10 . CKD also increases the likelihood that patients will present with ischemic ulceration or gangrene which substantially increases the risk of limb amputation 4,10,11 . In addition to increasing risk of mortality and amputation, CKD also increases the failure rate of endovascular/revascularization surgical interventions in PAD 3,12,13 .…”

Section: Introductionmentioning

confidence: 99%

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Berru¹,

Gray²,

Thome³

et al. 2019

Sci Rep

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Chronic kidney disease (CKD) substantially increases the severity of peripheral arterial disease (PAD) symptomology, however, the biological mechanisms remain unclear. The objective herein was to determine the impact of CKD on PAD pathology in mice. C57BL6/J mice were subjected to a diet-induced model of CKD by delivery of adenine for six weeks. CKD was confirmed by measurements of glomerular filtration rate, blood urea nitrogen, and kidney histopathology. Mice with CKD displayed lower muscle force production and greater ischemic lesions in the tibialis anterior muscle (78.1 ± 14.5% vs. 2.5 ± 0.5% in control mice, P < 0.0001, N = 5–10/group) and decreased myofiber size (1661 ± 134 μm2 vs. 2221 ± 100 μm2 in control mice, P < 0.01, N = 5–10/group). This skeletal myopathy occurred despite normal capillary density (516 ± 59 vs. 466 ± 45 capillaries/20x field of view) and limb perfusion. CKD mice displayed a ~50–65% reduction in muscle mitochondrial respiratory capacity in ischemic muscle, whereas control mice had normal mitochondrial function. Hydrogen peroxide emission was modestly higher in the ischemic muscle of CKD mice, which coincided with decreased oxidant buffering. Exposure of cultured myotubes to CKD serum resulted in myotube atrophy and elevated oxidative stress, which were attenuated by mitochondrial-targeted therapies. Taken together, these findings suggest that mitochondrial impairments caused by CKD contribute to the exacerbation of ischemic pathology.

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Section: Introductionmentioning

confidence: 99%

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Berru¹,

Gray²,

Thome³

et al. 2019

Sci Rep

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show abstract

“…Other studies focused on a population with specific comorbidities, such as chronic kidney disease requiring dialysis treatment . Even though foot ulcer risk is high in this population, the lack of specific reporting of findings for the patients at risk limits assessment of effectiveness of an intervention for at‐risk patients. For similar reasons, we did not assess the efficacy of lifestyle interventions or intensified glucose treatment, as they target a general population of patients with diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Netten

Raspovic

Lavery

et al. 2020

Diabetes Metabolism Res

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168

330

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Prevention of foot ulcers in patients with diabetes is important to help reduce the substantial burden on both patient and health resources. A comprehensive analysis of reported interventions is needed to better inform healthcare professionals about effective prevention. The aim of this systematic review is to investigate the effectiveness of interventions to help prevent both first and recurrent foot ulcers in persons with diabetes who are at risk for this complication. We searched the available medical scientific literature in PubMed, EMBASE, CINAHL, and the Cochrane databases for original research studies on preventative interventions. We screened trial registries for additional studies not found in our search and unpublished trials. Two independent reviewers assessed data from controlled studies for methodological quality, and extracted and presented this in evidence and risk of bias tables. From the 13,490 records screened, 35 controlled studies and 46 non‐controlled studies were included. Few controlled studies, which were of generally low to moderate quality, were identified on the prevention of a first foot ulcer. For the prevention of recurrent plantar foot ulcers, there is benefit for the use of daily foot skin temperature measurements, and for therapeutic footwear with demonstrated plantar pressure relief, provided it is consistently worn by the patient. For prevention of ulcer recurrence, there is some evidence for providing integrated foot care, and no evidence for a single session of education.Surgical interventions have been shown effective in selected patients, but the evidence base is small. Foot‐related exercises do not appear to prevent a first foot ulcer. A small increase in the level of weight‐bearing daily activities does not seem to increase the risk for foot ulceration. The evidence base to support the use of specific self‐management and footwear interventions for the prevention of recurrent plantar foot ulcers is quite strong. The evidence is weak for the use of other, sometimes widely applied, interventions, and is practically non‐existent for the prevention of a first foot ulcer and non‐plantar foot ulcer.

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“…Why renal complications are such a strong risk factor for amputations may be partly due to being a marker of high historic glycemic control and an overall high risk of complications. However, it is also possible that other mechanisms associated with renal complications such as hypertension, reduced albumin levels, inflammatory processes, and factors of the dialysis process may play an essential role for lower extremity amputations 8 9 25–27. To prevent amputations, screening for neuropathy and ulcers and performing preventive foot care are of importance, which often require specialist foot teams for people with diabetes and severe ulcers 13…”

Section: Discussionmentioning

confidence: 99%

Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

Ólafsdóttir

Svensson

Pivodic

et al. 2019

BMJ Open Diab Res Care

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ObjectiveThis study investigates how the excess risk of lower extremity amputations (amputations) in people with type 1 diabetes mellitus (DM) differs from the general population by diabetes duration, glycemic control, and renal complications.Research design and methodsWe analyzed data from people with type 1 DM from the Swedish National Diabetes Register without prior amputation from January 1998 to December 2013. Each person (n=36 872) was randomly matched with five controls by sex, age, and county (n=184 360) from the population without diabetes. All were followed until first amputation, death or end of follow-up.ResultsThe overall adjusted HR for all amputation was 40.1 (95% CI 32.8 to 49.1) for type 1 DM versus controls. HR increased with longer diabetes duration. The incidence of amputation/1000 patient-years was 3.18 (95% CI 2.99 to 3.38) for type 1 DM and 0.07 (95% CI 0.05 to 0.08) for controls. The incidence decreased from 1998–2001 (3.09, 95% CI 2.56 to 3.62) to 2011–2013 (2.64, 95% CI 2.31 to 2.98). The HR for major amputations was lower than for minor amputations and decreased over the time period (p=0.0045). Worsening in glycemic control among patients with diabetes led to increased risk for amputation with an HR of 1.80 (95% CI 1.72 to 1.88) per 10 mmol/mol (1%) increase in hemoglobin A1c.ConclusionsAlthough the absolute risk of amputation is relatively low, the overall excess risk was 40 times that of controls. Excess risk was substantially lower for those with good glycemic control and without renal complications, but excess risk still existed and is greatest for minor amputations.

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

Cited by 42 publications

References 52 publications

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Chronic kidney disease exacerbates ischemic limb myopathy in mice via altered mitochondrial energetics

Prevention of foot ulcers in the at‐risk patient with diabetes: a systematic review

Excess risk of lower extremity amputations in people with type 1 diabetes compared with the general population: amputations and type 1 diabetes

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