Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2014:2014:945075.
doi: 10.1155/2014/945075. Epub 2014 Mar 3.

Implications of foot ulceration in hemodialysis patients: a 5-year observational study

Hassan Al-Thani  1 , Ayman El-Menyar  2 , Valsa Koshy  1 , Ahmed Hussein  1 , Ahmed Sharaf  1 , Mohammad Asim  3 , Ahmed Sadek  1
Affiliations
Observational Study

Implications of foot ulceration in hemodialysis patients: a 5-year observational study

Hassan Al-Thani et al. J Diabetes Res. 2014.

Abstract

Foot ulceration (FU) remains a serious concern for patients worldwide. We analyzed the incidence, risk factors, and outcome of FU in hemodialysis (HD) patients. A retrospective cohort study was conducted for 252 HD patients who were followed up for 5 years. Patients were categorized according to whether they developed FU or not. The FU group (17%) was older and had significantly higher incidence of nephropathy, retinopathy, peripheral (PAD), coronary artery disease (CAD), and diabetes mellitus (DM) as compared to no-FU group. FU group had higher frequency of major amputation (P = 0.001) and HD vascular access (P = 0.01). Patients with combined DM and PAD had a 10-fold increased risk of FU in comparison to those who had DM alone. Presence of PAD was the main independent predictor for development of FU in HD with an adjusted odd ratio (aOR) of 16.0 (95% CI: 4.41-62.18; P = 0.001). After adjusting for age, sex, and CAD, predictors for mortality were PAD (aOR 4.3), FU (aOR 3.6), and DM (aOR 2.6). FU is common in HD patients regardless of DM. However, the presence of PAD is significantly associated with more FU and mortality in HD. HD patients need intensive foot care and warrant progressive modification of vascular risk factors.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
Outcomes in HD patients based on the presence of DM (P = 0.001 for all).
Figure 3
Figure 3
Outcomes in HD patients based on the presence/absence of DM and/or PAD (P = 0.001 for all).
Figure 4
Figure 4
Figure 5
Figure 5
See this image and copyright information in PMC

References

    1. Eggers PW, Gohdes D, Pugh J. Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. Kidney International. 1999;56(4):1524–1533. - PubMed
    1. O’Hare A, Johansen K. Lower-extremity peripheral arterial disease among patients with end-stage renal disease. Journal of the American Society of Nephrology. 2001;12(12):2838–2847. - PubMed
    1. Lamar Welch VL, Casper M, Greenlund K, Zheng Z-J, Giles W, Rith-Najarian S. Prevalence of lower extremity arterial disease defined by the ankle-branchial index among American Indians: the inter-tribal heart project. Ethnicity and Disease. 2002;12(1):S1–S1. - PubMed
    1. Morbach S, Quante C, Ochs HR, Gaschler F, Pallast JM, Knevels U. Increased risk of lower-extremity amputation among Caucasian diabetic patients on dialysis. Diabetes Care. 2001;24(9):1689–1690. - PubMed
    1. O’Hare AM, Bacchetti P, Segal M, Hsu C-Y, Johansen KL. Mortality Study Waves: Factors associated with future amputation among patients undergoing hemodialysis: results from the dialysis morbidity and mortality study waves 3 and 4. The American Journal of Kidney Diseases. 2003;41(1):162–170. - PubMed

Publication types

MeSH terms

LinkOut - more resources