Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: a prospective observational cohort study
journal contributionposted on 26.05.2021, 06:46 by Michelle Kaminski, Katrina Lambert, Anita Raspovic, LP McMahon, Bircan Erbas, PF Mount, PG Kerr, Karl Landorf
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.
MRK received an Australian National Health and Medical Research Council (NHMRC) PhD Scholarship (GNT 1056105). The study design; collection, analysis, and interpretation of data; the writing of the report; and in the decision to submit the article for publication are those of the authors, and not those of the Australian National Health and Medical Research Council.
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Science & TechnologyLife Sciences & BiomedicineUrology & NephrologyAmputationChronic kidney failureDialysisFoot ulcerRisk factorsCHRONIC KIDNEY-DISEASELOWER-EXTREMITY AMPUTATIONDIABETIC-PATIENTSHEMODIALYSISCAREMANAGEMENTSURVIVALULCERSHumansCerebrovascular DisordersPeripheral Nervous System DiseasesKidney Failure, ChronicFoot UlcerNail DiseasesRecurrenceRenal DialysisProportional Hazards ModelsRisk FactorsRegression AnalysisProspective StudiesAgedVictoriaFemaleMale