Prevalence and Risk Factors of Lower Limb Amputation in Patients with End-Stage Renal Failure on Dialysis: A Systematic Review

Abstract

Background. Renal dialysis has recently been recognised as a risk factor for lower limb amputation (LLA). However, exact rates and associated risk factors for the LLA are incompletely understood. Aim. Prevalence and risk factors of LLA in end-stage renal failure (ESRF) subjects on renal dialysis were investigated from the existing literature. Methods. Published data on the subject were derived from MEDLINE, PubMed, and Google Scholar search of English language literature from January 1, 1980, to July 31, 2015, using designated key words. Results. Seventy studies were identified out of which 6 full-text published studies were included in this systematic review of which 5 included patients on haemodialysis alone and one included patients on both haemodialysis and peritoneal dialysis. The reported findings on prevalence of amputation in the renal failure on dialysis cohort ranged from 1.7% to 13.4%. Five out of the six studies identified diabetes as the leading risk factor for amputation in subjects with ESRF on renal dialysis. Other risk factors identified were high haemoglobin A1c, elevated c-reactive protein, and low serum albumin. Conclusions. This review demonstrates high rate of LLA in ESRF patients receiving dialysis therapy. It has also identified diabetes and markers of inflammation as risk factors of amputation in ESRF subjects on dialysis.

Prevalence of foot ulcers in dialysis‐dependent patients

“…Although the difference was not significant, the prevalence of foot ulcers in patients with DM was 39.4% higher than in the group of patients without diabetes. The prevalence of amputation during this study, 8/66 (12.1%), is comparable with the range mentioned in the literature (1.7–13.4%) …”

“…The prevalence of amputation during this study, 8/66 (12.1%), is comparable with the range mentioned in the literature (1.7-13.4%). 36 A previous study described that renal insufficiency is independently associated with a distal obstructive pattern of symptomatic lower-limb atherosclerosis. 37 Our results 38 Physical function is significantly lower in the group with foot ulceration than in the group without foot ulceration.…”

Trends in Rates of Lower Extremity Amputation Among Patients With End-stage Renal Disease Who Receive Dialysis

“…Although older age is a known risk factor for PAD among patients without ESRD, 1,22 the same may not be true for patients who receive dialysis. 8,10 In a study evaluating amputation trends among patients with ESRD from 1991 through 1994, the peak amputation rate occurred between 45 and 54 years of age for patients with diabetes and between 55 and 64 years of age for patients without diabetes. 12 Similarly, an international study of 29 838 patients receiving hemodialysis in the Dialysis Outcomes and Practice Patterns Study found that patients 65 to 74 years of age and those 75 years or older had significantly lower odds of amputation than patients 55 to 64 years of age.…”

High Incidence of Adverse Outcomes in Haemodialysis Patients with Diabetes with or without Diabetic Foot Syndrome: A 5-Year Observational Study in Lleida, Spain

“…It has been estimated that up to 95% of dialysis-treated diabetic patients are at high risk of foot problems, and HD itself is an independent risk factor for foot ulceration, non-healing, and amputation [ 15 , 16 , 17 ]. About 20% of DM patients will develop a FU one year after dialysis initiation, and they also have a higher incidence of new amputations and foot-related hospitalizations [ 18 , 19 , 20 ]. Risk factors, associated with the likelihood of developing a foot ulcer or lower limb amputation, other than DM, when in maintenance dialysis, are peripheral artery disease (PAD), peripheral neuropathy (PN), and coronary artery disease (CAD) [ 21 , 22 , 23 ].…”