As Kidney Health Week gets underway this month, let’s reflect on the risk factors for foot ulceration experienced by people with end-stage renal disease on dialysis, as outlined in the below edited study excerpt. You can read the study in full here.
Although risk factors for ulceration have been extensively studied in patients with diabetes, there is surprisingly limited high-quality evidence in the dialysis population, despite an estimated 14% prevalence. Both foot salvage and survival rates are poor in these patients; only half survive 12 months after amputation.
To address this gap, a range of clinical, demographic, health status, and foot examination information was prospectively collected on 450 adults with end-stage renal disease from satellite and home-therapy dialysis units in Melbourne, Australia over 12 months. The primary outcome was foot ulceration.
The results are interesting, as below.
- Among 450 dialysis patients, new cases of foot ulceration were identified in 81 (18%) participants.
- Overall, risk factors for foot ulceration were neuropathy (HR 3.02; 95% CI 1.48 to 6.15) and previous ulceration (HR 2.86; CI 1.53 to 5.34).
- In those without history of ulceration, nail pathology (RR 3.85; CI 1.08 to 13.75) and neuropathy (RR 2.66; CI 1.04 to 6.82) were risk factors.
- In those with history of ulceration, neuropathy (RR 11.23; CI 3.16 to 39.87), peripheral arterial disease (RR 7.15; CI 2.24 to 22.82) and cerebrovascular disease (RR 2.08; CI 1.04 to 4.16) were risk factors.
- There were 12 (2.7%) new amputations, 96 (21.3%) infections, 24 (5.3%) revascularizations, 42 (9.3%) foot-related hospitalisations, and 52 (11.6%) deaths.
In conclusion, neuropathy and previous ulceration are proven major risk factors for foot ulceration in dialysis patients. Risk factors differ between those with and without prior ulceration. The risk factors identified will help to reduce the incidence of ulceration and its associated complications.
To read the full study and learn more about this issue, head here.
Support Kidney Health Week and continue to be alert to lower limb symptoms of kidney disease (such as pins and needles or puffiness in the legs). You can download a range of patient-facing resources here.