The association between renal failure and foot ulcer or lower extremity amputation in those patients with diabetes

Abstract

Objective: The objective of this study was to evaluate in those with diabetes the association between foot ulcer (DFU) and lower extremity amputation (LEA) and chronic kidney disease (CKD).

Design: A retrospective cohort study of individuals enrolled between 2002 and 2006.

Setting: Individuals cared for in general practice who were between 35 years of age and older with a history of diabetes mellitus.

Datasources: Physicians who participate in The Health Information Network of the United Kingdom.

Main outcome and measurements: The presence of DFU or LEA and estimated glomerular filtration rate (eGFR).

Results: 90,617 individuals were fully evaluated with a median time of observation of 2.4 years. 378 individuals had LEA and 2619 had DFU. CKD (eGFR<60 ml/min/1.73m²) was noted in 23,350 (26%) of our cohort. For the development of DFU as compared to our reference group (group 1 (eGFR ≥ 60 ml/min/1.73m²)) the hazard ratios were for group 2 (eGFR ≥30 and <60 ml/min/1.73m²) of 1.85 (1.71, 2.01) and for group 3 (eGFR <30 ml/min/1.73m²) of 3.92 (3.23, 4.75) (all p-values <0.001). For LEA the hazard ratios for group 2 was 2.08 (1.68, 2.58) and for group 3 was 7.71 (5.29, 11.26) (all p-values <0.001).

Limitations: This was an observational study.

Conclusions: There is a strong association between stage of CKD and DFU or LEA, which is likely not just related to presence of peripheral arterial disease. Individuals with even moderate CKD (eGFR <60 ml/min/1.73m²) are at increased risk for DFU and LEA.