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. 2022 Jan;5(1):e00305.
doi: 10.1002/edm2.305. Epub 2021 Oct 17.

Micro- and macrovascular complications and risk factors for foot ulceration and amputation in individuals receiving dialysis with and without diabetes

Dea Haagensen Kofod  1 , Thomas Peter Almdal  2   3 , Vibeke Rømming Sørensen  1 , Bo Feldt-Rasmussen  1   3 , Mads Hornum  1   3
Affiliations

Micro- and macrovascular complications and risk factors for foot ulceration and amputation in individuals receiving dialysis with and without diabetes

Dea Haagensen Kofod et al. Endocrinol Diabetes Metab. 2022 Jan.

Abstract

Introduction: This study examined the prevalence of microvascular and macrovascular complications in people receiving dialysis with and without diabetes and investigated independent risk factors for foot ulcers and lower-extremity amputations.

Methods: We performed a cross-sectional study of 119 individuals with diabetes and 219 individuals without diabetes receiving chronic dialysis during June 2019 at the Department of Nephrology, Rigshospitalet, University of Copenhagen, Denmark. Effects of diabetes and other risk factors were assessed by log-binomial regression. Prevalence data were compared with a historical control group of 38 individuals with diabetes receiving dialysis examined in 2004 in the same department.

Results: We found that persons with diabetes had a twofold higher risk ratio of current (unadjusted risk ratio 2.2 [95% CI 1.1, 4.7]) and previous foot ulcer (2.5 [1.7, 3.7]) and a fourfold higher risk ratio of lower-extremity amputation (4.2 [2.1, 8.6]) in comparison with persons without diabetes (all p < .05). Furthermore, persons with diabetes had a 70% increased risk ratio of myocardial infarction (1.7 [1.0-2.8], p = .041). In multivariable-adjusted analysis, current foot ulcer was independently associated with previous foot ulcer (adjusted risk ratio 4.0 [95% CI 1.8, 8.9]), while lower-extremity amputation was independently associated with diabetes (3.8 [1.8, 8.2]) and male sex (4.1 [1.5, 11.3]) (all p < .01).

Conclusions: Individuals with diabetes receiving dialysis had a higher prevalence of foot ulcer, lower-extremity amputation and myocardial infarction compared to individuals without diabetes. Previous foot ulcer was the most important risk factor for current foot ulcer, while diabetes and male sex were important risk factors for lower-extremity amputation.

Keywords: diabetes complications; diabetes mellitus; diabetic foot; dialysis; end-stage renal disease; epidemiology.

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Conflict of interest statement

The authors have no conflicts of interest to declare for this study.

Figures

FIGURE 1
FIGURE 1
Flow diagram of study groups
FIGURE 2
FIGURE 2
Prevalence of complications in individuals with and without diabetes receiving dialysis in 2019 and individuals with diabetes receiving dialysis in 2004. *p < .05
FIGURE 3
FIGURE 3
Temporal relationship between first foot ulcer or first lower‐extremity amputation and start of dialysis in individuals with and without diabetes receiving dialysis in 2019. *p < .05
See this image and copyright information in PMC

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