SLR - June 2023 - Puja Manhar Patel, DPM PGY-2
Title: The association between estimated glomerular filtration rate and prognosis in patients with diabetic foot osteomyelitisReference: Zhang J, Chen D, Li X, Ding M, Xu J, Wang M, Chang B. The association between estimated glomerular filtration rate and prognosis in patients with diabetic foot osteomyelitis. Int Wound J. 2022 Nov;19(7):1650-1657. doi: 10.1111/iwj.13765. Epub 2022 Jan 25. PMID: 35080116; PMCID: PMC9615297.
Level of Evidence: II
Scientific Literature Review
Reviewed By: Puja Manhar Patel, DPM PGY-2
Residency Program: Baylor Scott & White in Temple, Texas
Podiatric Relevance: Patients with diabetic foot ulcerations/osteomyelitis are commonly associated with renal insufficiency. Understanding the impact and risk factor that renal insufficiency has on healing and amputation rates is important. Estimated glomerular filtration rate is an outcome that can be monitored during the treatment of patients with diabetic foot ulcerations or osteomyelitis especially if treatment involves antibiotics. There are many risk factors to wound healing or amputation rates and severely reduced eGFR is another independent predictor.
Methods: A Level 2, prospective cohort study was performed on 321 diabetic foot osteomyelitis patients. Patients met the International Working Group on the Diabetic Foot diagnostic criteria and treatment was based on the guidelines from IWGDF. Follow up consisted of enrollment to 6 months or death. Patients were divided into four groups based on estimated glomerular filtration rate (eGFR): normal, mildly reduced, moderately reduced, and severely reduced. The prognosis of ulcer healing or minor/major amputation when compared to patient levels of eGFR were analyzed with univariate and multivariate logistic regression models. Other factors were also measured: hemoglobin A1c, diabetes duration, blood pressure, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol.
Results: Patients who have severely reduced eGFR have higher risk of ulcer healing failure, total amputation, and minor amputation. There was no statistical difference in mild or moderately reduced eGFR categories compared to normal eGFR. The secondary outcome measures for HbA1c, diabetes duration, blood pressure, triglycerides were statistically significant in the severely reduced eGFR group.
Conclusions: The authors concluded that diabetic patients with severely reduced eGFR have a higher risk of failure to heal diabetic foot ulcers and greater risk for minor and major amputation. There were limitations in the study: small sample size and short follow up. Monitoring eGFR levels, renally dose antibiotic treatment, and evaluating renal insufficiency for predicting outcomes will be helpful for care management.