Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: a prospective observational cohort study

BMC Nephrology

Peter F. Mount¹  Peter G. Kerr²  Katrina A. Lambert³  Bircan Erbas³  Lawrence P. McMahon⁴  Karl B. Landorf⁵  Anita Raspovic⁵  Michelle R. Kaminski⁵ 

[1] Department of Nephrology, Austin Health, University of Melbourne;Department of Nephrology, Monash Health;Department of Public Health, School of Psychology and Public Health, La Trobe University;Departments of Renal Medicine & Obstetric Medicine, Eastern Health Clinical School, Monash University;Discipline of Podiatry, School of Allied Health, Health Services and Sport, La Trobe University;

关键词: Amputation;    Chronic kidney failure;    Dialysis;    Foot ulcer;    Risk factors;   

DOI  :  10.1186/s12882-019-1594-5

来源: DOAJ

【 摘 要 】

Abstract Background Dialysis patients experience high rates of foot ulceration. Although risk factors for ulceration have been extensively studied in patients with diabetes, there is limited high-quality, longitudinal evidence in the dialysis population. Therefore, this study investigated risk factors for foot ulceration in a stable dialysis cohort. Methods We prospectively collected clinical, demographic, health status, and foot examination information 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. Cox proportional hazard modelling and multinomial regression were used to investigate risk factors. Results Among 450 dialysis patients (mean age, 67.5 years; 64.7% male; 94% hemodialysis; 50.2% diabetes), 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 hospitalizations, and 52 (11.6%) deaths. Conclusions Neuropathy and previous ulceration are 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.

【 授权许可】

Unknown