SLR - October 2010 - Amy Barko
Reference: Ndip, A., Lavery, L., LaFontaine, J., Rutter, M., Vardhan, A., Vileikyte, L., Boulton, A. (2010). High Levels of Foot Ulceration and Amputation Risk in a Multiracial Cohort of Diabetic Patient on Dialysis Therapy. Diabetes Care, 33, 695-949.
Scientific Literature Reviews
Reviewed by: Amy Barko, DPM PGY-1
Residency Program: OCPM/UHHS-RMC
Podiatric Relevance:
Foot ulceration and amputation risk is something a podiatrist should always be focused on with respect to diabetic patients. They should also be aware of which complications would increase the risk of these ailments. In the literature, significant ethnic differences in lower limb complications have been reported. This study was aimed at diabetic patients of different ethnicities who were on dialysis.
Methods:
This is a prospective cross-sectional study with 466 patients who had diabetes and were receiving dialysis therapy from centers in the U.S. and the U.K. Patients were interviewed and had a foot examination including a neurological and arterial assessment. The International Working Group on the Diabetic Foot (IWGDF) risk classification was used to put patients into 4 groups. The categories were 0: no recognizable risk factor, 1: neuropathy and no other risk factors, 2: PAD with or without neuropathy, 3: prevalent foot ulceration, a history of foot ulcer, or prior amputation. Ethnicity was based on patient's self report. 88% of the patients were on hemodialysis and the rest were receiving peritoneal dialysis.
Results:
A high prevalence of PAD and peripheral neuropathy and a moderately high prevalence of past foot ulceration and amputation was observed without variance by ethnicity. The only foot complication that varied by ethnicity was current foot ulceration which affected 1 in 8 white patients. This was a higher prevalence than patients of African descent, but not significantly higher than Asians or Hispanics. Based on IWGDF risk categories, 95% of all patients were considered high risk.
Conclusions:
In conclusion, a high prevalence of lower-limb complications were reported in a large, ethnically diverse cohort of diabetic patients on dialysis, with up to 95% of patients having at least one risk factor. Contrary to previous studies, no ethnic variation was found in foot complications in dialysis treated diabetics. Most likely, the finding of no ethnic variation is thought to be due to the significant burden of end-stage disease where ethnic differences become relatively insignificant. It was also concluded that patients that are diabetic and on dialysis should be considered at high risk. Patients might need cooperation of foot evaluators before or after dialysis due to the fact that they are so focused on dialysis they might be neglecting this evaluation.