Association Between Renal Failure and Foot Ulcer or Lower-Extremity Amputation in Patients With Diabetes
Year: 2008
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: The objective of this study was to evaluate the association between foot ulcers (DFU) and lower-extremity amputation (LEA) and chronic kidney disease (CKD) in patients with diabetes. RESARCH DESIGN AND METHODS: This was a retrospective cohort study of individuals enrolled between 2002 and 2006 who were aged > or =35 years, had a history of diabetes, and were cared for in general practice. The physicians participated in The Health Information Network of the U.K. RESULTS: The presence of DFU or LEA and estimated glomerular filtration rate (eGFR) were evaluated in 90,617 individuals with a median time of observation of 2.4 years. Of these individuals 378 had an LEA and 2,619 had a DFU. CKD (eGFR <60 ml/min per 1.73 m(2)) was noted in 23,350 (26%) individuals in our cohort. For the development of DFU compared with our reference group (group 1 [eGFR > or =60 ml/min per 1.73 m(2)]), the hazard ratio (HR) for group 2 (eGFR > or =30 and <60 ml/min per 1.73 m(2)) was 1.85 (95% CI 1.71-2.01) and for group 3 (eGFR <30 ml/min per 1.73 m(2)) was 3.92 (3.23-4.75) (all P < 0.001). For LEA, the HR for group 2 was 2.08 (1.68-2.58) and for group 3 was 7.71 (5.29-11.26) (all P < 0.001). CONCLUSIONS: In this observational study, there is a strong association between stage of CKD and DFU or LEA that is probably not just related to the presence of peripheral arterial disease. Individuals with even moderate CKD (eGFR <60 ml/min per 1.73 m(2)) have an increased risk for DFU and LEA.
Source: Diabetes Care
DOI: 10.2337/dc07-2244
Authors: David J. Margolis, Ole Hofstad, Harold I. Feldman
Institution: University of Pennsylvania
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W2107156571