High rates of lower limb amputation in patients with diabetes end stage renal failure on hemodialysis: Is there a causal factor?

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Authors: Gilhotra,R. A.;Rodrigues,B. T.;Malabu,U. H.;Vanagaveti,V.;Kan,G.;Sangla,K. S.

Publication: Endocrine reviews

Year: 2014

Volume: 35

 

ABSTRACT:

Hemodialysis has recently been identified as a risk factor for lower limb amputations (1,2). In spite of this no study has been published that analyses the magnitude and risk factors for amputation amongst hemodialysis patients in rural and remote communities and Indigenous Australian residents of the Tropical Northern region where diabetes and kidney disease are quite common (3). The objectives of this study were to document trends in prevalence and identify risk factors of non-traumatic lower limb amputations in diabetes subjects treated with hemodialysis in the region. 155 current haemodialysis patients attending the Townsville Dialysis Centre were included in the study. Odds ratio and χ2 tests were performed to identify variables most strongly associated with amputation. We identified a 13.6% prevalence of lower limb amputation in 155 subjects on hemodialysis at our centre. The major risk factors of amputations in the cohort were history of ulceration (RR 24.74 [95%CI 6.02-101.76] p<0.0001) and the presence of diabetes (RR 23.19 [95%CI 1.43-375.49] p=0.027). Other variables tested but fell short of statistical significance included: Indigenous background, smoking history, gender and type of ulceration. Thus, patients with end stage renal failure on hemodialysis who have a past history of ulceration and have diabetes mellitus are at higher risk of having lower limb amputation. Primary prevention of diabetes in the sub-population may help in reducing the limb loss. In-depth analysis of the data will be presented at the conference.

  • Listing ID: 4611
  • Author/s: Gilhotra,R. A.;Rodrigues,B. T.;Malabu,U. H.;Vanagaveti,V.;Kan,G.;Sangla,K. S.
  • Publication: Endocrine reviews
  • Year: 2014
  • Volume: 35
  • Article Keywords: patient;human;diabetes mellitus;end stage renal disease;hemodialysis;society;leg amputation;risk factor;ulcer;amputation;prevalence;risk;hemodialysis patient;population;kidney disease;primary prevention;gender;smoking;Indigenous Australian;statistical significance;limb;dialysis;community