Preventing amputations in patients with diabetes and renal disease

Abstract

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.

Management of adults with diabetes on the haemodialysis unit: summary of guidance from the Joint British Diabetes Societies and the Renal Association

“…End‐stage renal failure and CKD 4–5 are independent risk factors for foot disease, neuropathy, peripheral arterial disease, delayed wound healing, amputation and post‐amputation mortality. Dialysis/renal replacement therapy is strongly and independently associated with foot ulcers . Neuropathy greatly increases the risk of pressure‐related ulcers, and care must be taken to ensure adequate pressure relief on heels in renal dialysis units when the person is recumbent for prolonged periods .…”

What is the Lived Experience of the ‘Three Great Pathologies’ of Diabetic Foot Disease? An Interpretative Phenomenological Analysis of the Independent Thinking of Podiatrists in Diabetes Secondary Care

“…21 The increased prevalence of infections and DFD in this cohort occurs for some well understood reasons, such as the presence of ischaemia and neuropathy which is then intensified by end stage renal failure, which leads to an increased prevalence of DFD. 22 This research will inform a better understanding of the TGP and create a focus which may improve the quality of services provided by podiatrists.…”

“…21 The increased prevalence of infections and DFD in this cohort occurs for some well understood reasons, such as the presence of ischaemia and neuropathy which is then intensified by end stage renal failure, which leads to an increased prevalence of DFD. 22…”

Management of adults with diabetes on the haemodialysis unit: summary of new guidance from the Joint British Diabetes Societies (JBDS) and the Renal Association

“…Dialysis/ renal replacement therapy is strongly and independently associated with foot ulcers. [39][40][41][42] Neuropathy greatly increases the risk of pressurerelated ulcers, and care must be taken to ensure adequate pressure relief on patients' heels in renal dialysis units when they are recumbent for prolonged periods. 43 Podiatry input on dialysis units reduces the frequency and severity of diabetic foot complications: regular podiatry assessment (at least 3-monthly) should be ensured, ideally on dialysis units as this frail, multi-morbid population may have difficulty accessing community podiatry services.…”