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2017 ; 18
(1
): 293
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Factors associated with foot ulceration and amputation in adults on dialysis: a
cross-sectional observational study
#MMPMID28886703
Kaminski MR
; Raspovic A
; McMahon LP
; Lambert KA
; Erbas B
; Mount PF
; Kerr PG
; Landorf KB
BMC Nephrol
2017[Sep]; 18
(1
): 293
PMID28886703
show ga
BACKGROUND: Adults on dialysis are at increased risk of foot ulceration, which
commonly precedes more serious lower limb complications, including amputation.
Limited data exist regarding the prevalence and factors associated with foot
disease in this population. Hence, this study set out to investigate factors
associated with foot ulceration and amputation in a dialysis cohort. METHODS:
This study presents a cross-sectional analysis of baseline data from a
multi-center prospective cohort study. We recruited 450 adults with end-stage
renal disease on dialysis from multiple satellite and home-therapy dialysis units
in Melbourne, Australia from January to December 2014. Data collection consisted
of a participant interview, medical record review, health-status questionnaire
and non-invasive foot examination. Logistic regression analyses were conducted to
evaluate associations between screened variables and study outcomes. RESULTS:
Mean age was 67.5 (SD, 13.2) years, 64.7% were male, 94% were on hemodialysis,
median dialysis duration was 36.9 (IQR, 16.6 to 70.1) months, and 50.2% had
diabetes. There was a high prevalence of previous ulceration (21.6%) and
amputation (10.2%), 10% had current foot ulceration, and 50% had neuropathy
and/or peripheral arterial disease. Factors associated with foot ulceration were
previous amputation (OR, 10.19), peripheral arterial disease (OR, 6.16) and serum
albumin (OR, 0.87); whereas previous and/or current ulceration (OR, 167.24 and
7.49, respectively) and foot deformity (OR, 15.28) were associated with
amputation. CONCLUSIONS: Dialysis patients have a high burden of lower limb
complications. There are markedly higher risks of foot ulceration and/or
amputation in those with previous and/or current ulceration, previous amputation,
peripheral arterial disease, lower serum albumin, and foot deformity. Although
not a major risk factor, diabetes in men was an important effect modifier for
risk of ulceration.