Increased Risk of Lower-Extremity Amputation Among Caucasian Diabetic Patients on Dialysis

Morbach, Stephan; Quante, C.; Ochs, Hermann R.; Gaschler, F; Pallast, Jean-Mario; Knevels, Udo

doi:10.2337/diacare.24.9.1689

Cited by 49 publications

(56 citation statements)

References 7 publications

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“…This holds true for all foot complications, namely ulceration, infection, gangrene, and amputation, which are encountered at a more than twofold frequency in diabetic patients with ESRD as compared with their non-nephropathic counterparts. [38,39] Tragically enough, the rate of amputations is 6.5-10 times higher among diabetic patients with ESRD in comparison to the general diabetic population. [39][40][41] Similarly, the presence of renal disease confers a dismal prognosis in terms of all foot-related outcomes among patients with diabetes.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

“…[49] Patients on dialysis, thus, fare the worst. In the study by Morbach et al (2001), the rate of amputation was 57% among patients on hemodialysis compared with 25% in those with pre-dialysis renal failure (p = 0.006). [39] In a similar fashion, the risk of poor outcome among longstanding diabetes with critical foot ischemia was increased 8.9 times in those on dialysis.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

“…In the study by Morbach et al (2001), the rate of amputation was 57% among patients on hemodialysis compared with 25% in those with pre-dialysis renal failure (p = 0.006). [39] In a similar fashion, the risk of poor outcome among longstanding diabetes with critical foot ischemia was increased 8.9 times in those on dialysis. [51] Moreover, there is a close temporal association between commencement of dialysis and occurrence of foot complications.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

“…[43,56,58] Yet foot lesions are, rather, attributable to a combination of both entities. [39,59,60] Certainly, diabetic nephropathy, especially ESRD, is accompanied by an increased prevalence of peripheral arterial disease, [5,6,60] largely associated with longer diabetes duration [5,6,59] but also with a significantly more frequent presence of vascular risk factors. [5,61] Similarly, neuropathy is particularly common, possibly aggravated by a component of uremic neuropathy.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

“…[38,39] Tragically enough, the rate of amputations is 6.5-10 times higher among diabetic patients with ESRD in comparison to the general diabetic population. [39][40][41] Similarly, the presence of renal disease confers a dismal prognosis in terms of all foot-related outcomes among patients with diabetes. [42][43][44][45][46][47] Griffiths et al (1990) found that reduced creatinine clearance increased the risk for foot ulceration.…”

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

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The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies-neuropathy, ischemia, and infection-are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.

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Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

Section: The Diabetic Foot In Esrdmentioning

confidence: 99%

See 3 more Smart Citations

The Diabetic Foot in End Stage Renal Disease

et al. 2007

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Preventing amputations in patients with diabetes and renal disease

Game

2012

Practical Diabetes

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Diabetes remains the single most common cause of both end stage renal disease and non‐traumatic amputation of the lower limb. The available literature confirms a close association between renal disease, peripheral symmetrical neuropathy, peripheral vascular disease, foot ulcers, amputation and survival in patients with diabetes, and suggests that the risk accelerates soon after the start of renal replacement therapy. There are multiple possible mechanisms underlying the association, including the effects of dialysis on tissue hypoxia. At present there are no specific interventions known to improve these pathogenic mechanisms; however, there is evidence to suggest that the organisation of care could have an impact on the onset of foot disease. These patients therefore should have regular foot surveillance, education, and support from appropriate specialists to manage their foot care. All professionals involved in the care of patients with diabetes and renal disease should be aware of the extent to which the patient's feet are at risk. Copyright © 2012 John Wiley & Sons.

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Diabetes, established renal failure and the risk to the lower limb

Hinchliffe

Game

2006

Pract Diab Int

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The aim of this article is to review the extent of the association between established renal failure, foot ulcers, gangrene and amputation in diabetes, and to consider the possible mechanisms and clinical implications. In order to do this we used our personal knowledge of the literature, supplemented by searches of Medline and PubMed using appropriate key words. The available literature confirms the close association between established renal failure, peripheral vascular disease, foot ulcers, gangrene and amputation, and indicates that this association is between three and five times greater in diabetes. Once they occur, foot complications are associated with a high mortality. There are multiple possible mechanisms underlying the association, and these include those leading to accelerated peripheral arterial disease, as well as the anaemia and metabolic features of renal failure. There is also evidence that the process of dialysis is itself associated with worsening tissue hypoxia. The results of lower limb revascularisation in established renal failure are poor. We conclude that there is a need for further detailed studies into the factors leading to this association, as well as into the effectiveness of potential interventions. The place of pre-emptive vascular intervention needs to be established. In the meantime, all those responsible for the management of impending and established renal failure in diabetes should remain aware of the possibility of foot disease and should ensure that a structured programme of preventive foot care is implemented.

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Increased Risk of Lower-Extremity Amputation Among Caucasian Diabetic Patients on Dialysis

Cited by 49 publications

References 7 publications

The Diabetic Foot in End Stage Renal Disease

The Diabetic Foot in End Stage Renal Disease

Preventing amputations in patients with diabetes and renal disease

Diabetes, established renal failure and the risk to the lower limb

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