Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

Abstract

Background: End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis. Objective: The study aims to document trends in the prevalence and identify risk factors of nontraumatic LLA in Australian patients on dialysis. Methods: A retrospective review of all patients (218) ] p¼ 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p < 0.05). Conclusion: There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels.

Major lower limb amputations in Far North Queensland

“…19,[23][24][25][26] A study from Townsville found that Indigenous patients were over-represented in their dialysis-dependent population, and that these patients were more likely to require MLLA compared to non-Indigenous patients on dialysis. 27 Previous reports have demonstrated that Indigenous Australians were four times more likely to be hospitalized for diabetes than non-Indigenous Australians, and an age-adjusted death rate from diabetes six times higher than non-Indigenous counterparts. 28 Diabetes is clearly a major contributor to MLLA in FNQ.…”

“…Indigenous Australians have poorer health outcomes in a variety of measures, with particularly high rates of diabetes clearly demonstrated to be a major causative factor for limb amputation . A study from Townsville found that Indigenous patients were over‐represented in their dialysis‐dependent population, and that these patients were more likely to require MLLA compared to non‐Indigenous patients on dialysis . Previous reports have demonstrated that Indigenous Australians were four times more likely to be hospitalized for diabetes than non‐Indigenous Australians, and an age‐adjusted death rate from diabetes six times higher than non‐Indigenous counterparts…”

“…About one‐third of patients undergoing MLLA in Cairns were dependent on dialysis, and no other Australian data were found to compare this to. A study from Townsville found that of the 218 dialysis‐dependent patients, 13.3% had undergone a lower limb amputation, with a total of nine patients (4%) undergoing MLLA . Interestingly, all dialysis‐dependent patients undergoing lower limb amputation also had concurrent diabetes .…”

“…A study from Townsville found that of the 218 dialysis-dependent patients, 13.3% had undergone a lower limb amputation, with a total of nine patients (4%) undergoing MLLA. 27 Interestingly, all dialysis-dependent patients undergoing lower limb amputation also had concurrent diabetes. 27 Multiple studies have concluded that patients requiring dialysis are at higher risk than the general population for MLLA, and this study confirms that in our cohort.…”

“…27 Interestingly, all dialysis-dependent patients undergoing lower limb amputation also had concurrent diabetes. 27 Multiple studies have concluded that patients requiring dialysis are at higher risk than the general population for MLLA, and this study confirms that in our cohort. [33][34][35] It has also been suggested that there is a correlation between the severity of chronic kidney disease and amputation, which may be independent of clinically apparently peripheral artery disease.…”