Amputation in people with diabetes and end-stage renal disease

New Australian research has been published confirming the high amputation risk for people with diabetes and end-stage renal disease. In a retrospective chart review, researchers at the James Cook University (Townsville) looked at all patients attending the Townsville Dialysis Center between 2009 and 2013. They found 9 major and 20 minor lower limb amputations, all in people with diabetes, leading to a prevalence of 13.3%. Well known risk factors were identified in the multivariate analysis, including previous foot ulcer, peripheral artery disease and peripheral neuropathy. A major risk factor found was indigenous heritage, with 75% of the amputations being performed in indigenous patients.

This is the first Australian study to report on amputation in people with diabetes and end-stage renal disease. While the research is limited by including a relatively small group of patients only, and using retrospective chart review as methods, this confirms findings of a high amputation risk in people with diabetes and end-stage renal disease, as seen in studies from (for example) the United States, the United Kingdom, the Netherlands, Germany and Italy. The risk factors found are also similar to those identified in a meta-analysis by Australian researchers from LaTrobe University. The same LaTrobe team is currently busy with a major prospective study on risk factors for both foot ulceration and amputation in this fragile population, to further enhance our knowledge of the Australian situation.

This all points at the importance of multidisciplinary foot care for people with end stage renal disease. Any patient with diabetes undergoing dialysis treatment is at high-risk for foot ulceration and lower limb amputation, and should receive optimal preventative foot care. When evidence-based diabetic foot care is implemented in dialysis centres, the burden of amputations in these patients can be reduced.