Prevalence of risk factors for foot ulceration in a general haemodialysis population

Abstract

It is well documented that diabetic foot ulceration contributes to increased morbidity and mortality associated with renal replacement therapy. Much less is known about the risk of foot ulceration and lower limb amputation in the non-diabetic dialysis population. The aim of this study was to determine if the prevalence of risks factors for lower limb amputation in a stable haemodialysis population was greater in the diabetic cohort compared with the non-diabetic cohort. The study design is a prospective observational cohort study. Sixty patients attending a satellite haemodialysis unit in Cardiff were invited to have a comprehensive foot assessment as part of a Podiatry service review. The medical notes and hospital information system were used to identify the diabetic cohort. Patients were classified according to diabetic status (diabetic versus non-diabetic). The Renal Foot Screening Tool was developed to prospectively identify risk factors associated with foot ulceration. The assessment included peripheral neuropathy (PN), peripheral arterial disease (PAD) and foot pathology (FP). Fifty-seven patients gave informed verbal consent prior to inclusion. Risk factors for foot ulceration were recorded at baseline in the diabetic (n = 24) and non-diabetic (n = 33) groups and mortality data was revisited after a 3-year period. FP was identified in 79% of patients. Eighteen per cent of the non-diabetic patients had PN. PAD was identified in 45% of diabetic and 30% of non-diabetic patients. Forty-nine per cent of the total cohort had ≥2 of the 3 independent risk factors for foot ulceration (16/24 diabetic versus 12/33 non-diabetic). The presence of PAD and PN was predictive of mortality independent of age. The limitations of this study are its small sample size and patients were from a single satellite dialysis unit. There was a high prevalence of risk factors for foot ulceration in this population, which were not confined to the diabetic cohort. These findings suggest that non-diabetic patients on haemodialysis therapy are also at risk of developing foot ulceration. Further work on strategies to monitor and prevent FP in this high-risk cohort is needed to minimize morbidity and mortality associated with foot ulceration.

Implications of Foot Ulceration in Hemodialysis Patients: A 5-Year Observational Study

“…The authors found an increased association of CVD and mortality in diabetic patients with FU in comparison to those without FU. Interestingly, a recent study advocated a higher incidence of risk factors (PAD and peripheral neuropathy) for FU among HD patients [13]. In Qatar, an earlier report from our center identified a high incidence of PAD in HD patients [14].…”

Prevalence of foot ulcers in dialysis‐dependent patients

“…All ulcers were included, because every ulcer should be recognized and treated to prevent escalation. [8][9][10]30 Another explanation could be that our data come forth of prospective clinical research instead of retrospective data, leading to a higher prevalence. Almost 70% of patients had a history of tobacco use and could cause the high prevalence.…”

“…The prevalence of foot ulcers in our study is high (31.8% vs. 8%). 8,10 In this study also ulcerations without exudate production, in which the overlying skin was not intact, were included. This distinction is not mentioned in other literature, which could explain the high prevalence of foot ulcers in our study.…”

“…7 Several studies have shown that risk factors for foot ulceration are more frequent in patients with end-stage renal failure combined with DM than in patients with secondary DM. [8][9][10] The cost of foot ulceration in diabetic patients is estimated on US$ 880 per year for preventive care per patient and approximately US$ 32.000 for hospitalization with amputation. 11,12 There is evidence that DM is a risk factor for developing a foot ulcer, [13][14][15][16] but these studies do not compare a full range of risk factors.…”

Use of Hand‐to‐hand Measurements for Body Composition Monitoring in Patients With Inaccessible or Amputated Feet

“…Dialysis treatment is an independent risk factor for ulceration and amputation of the foot (Ndip et al 2010) and it has been shown that dialysis is associated with a threefold increase in the development of foot ulcers compared with a population of those with diabetes, not on dialysis (Jones et al 2012). It is not uncommon to see patients undergoing dialysis with bandaged or amputated feet.…”