Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study

BMC Nephrology

Research Article

Katrina A. Lambert¹  Bircan Erbas¹  Peter F. Mount²  Peter G. Kerr³  Lawrence P. McMahon⁴  Anita Raspovic⁵  Michelle R. Kaminski⁵  Karl B. Landorf⁶ 

[1] College of Science, Health and Engineering, School of Psychology and Public Health, Department of Public Health, La Trobe University, 3086, Melbourne, VIC, Australia;Department of Nephrology, Austin Health, 3084, Melbourne, VIC, Australia;Department of Nephrology, Monash Health, 3168, Melbourne, VIC, Australia;Departments of Renal Medicine & Obstetric Medicine, Eastern Health Clinical School, Monash University, 3128, Melbourne, VIC, Australia;Discipline of Podiatry, School of Allied Health, La Trobe University, 3086, Melbourne, VIC, Australia;Discipline of Podiatry, School of Allied Health, La Trobe University, 3086, Melbourne, VIC, Australia;Melbourne Health, 300 Grattan Street, Parkville, 3050, Melbourne, VIC, Australia;

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

DOI  :  10.1186/s12882-017-0711-6

 received in 2016-12-14, accepted in 2017-09-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAdults 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.MethodsThis 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.ResultsMean 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.ConclusionsDialysis 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.

【 授权许可】

CC BY   
© The Author(s). 2017