SLR - September 2012 - David Gelbmann
Reference: Ndip, A., Rutter, M., Vileikyte, L., Vardhan, A., Asari, A., Jameel, M., Tahir, H., Lavery, L., Boulton, A. (2010) Dialysis Treatment is an Independent Risk Factor for Foot Ulceration in Patients with Diabetes and Stage 4 or 5 Chronic Kidney Disease. Diabetes Care. 33(8): 1811-1816.
Scientific Literature Review
Reviewed by: David Gelbmann, DPM
Residency Program: St. John Hospital and Medical Center
Podiatric Relevance:
As the incidence of diabetes rises every year, so too does the number of diabetic patients with chronic kidney disease who are receiving dialysis therapy. Several independent risk factors for foot ulceration have been found in the literature, such as diabetic peripheral neuropathy and renal failure, however, dialysis therapy has not been independently studied as such a factor. If identified as a risk factor, intensive foot care and further preventative measures should be employed within the population of diabetic patients receiving dialysis therapy.
Methods:
A cross-sectional retrospective study was conducted of patients with both diabetes mellitus and stage 4 or stage 5 chronic kidney disease treated in Manchester, U.K. between October 2006 and March 2008. Patients were classified as either receiving dialysis therapy or not. Foot assessment included diabetic peripheral neuropathy, peripheral arterial disease, prior foot ulceration and amputation, and foot self-care. Data at each clinic visit came from both patients and the medical, and the prevalence of foot ulcers was recorded. Risk factors for prevalent foot ulceration were assessed by logistical regression.
Results:
A total of 326 patients with both diabetes and chronic kidney disease, with a mean age of 64, were studied. Of these, 139 received dialysis and 187 did not. The prevalence of foot ulceration was 11 percent. Compared with no dialysis patients, patients with dialysis had a higher prevalence of foot ulceration: 21 percent versus five percent. Dialysis patients also had a higher prevalence of diabetic peripheral neuropathy (79 versus 65 percent), peripheral arterial disease (64 versus 43 percent), prior amputations (15 versus 6.4 percent) and prior foot ulceration (32 versus 20 percent). In multivariate logistic regression, only dialysis treatment and prior foot ulceration were associated with prevalent foot ulceration.
Conclusions:
Based on these results, dialysis treatment was independently associated with foot ulceration. Treatment guidelines should regard dialysis as a significant risk factor for foot ulceration, demanding intensive foot care and preventive measures within this patient population.