Diabetic foot disease in subjects with End-stage renal Disease: A nationwide study over 14 years highlighting an emerging threat

Lin, Cheng-Wei; Armstrong, David G.; Huang, Chung-Huei; Lin, Chia-Hung; Hung, Shih-Yuan; Liu, Pi-Hua; Huang, Yu‐Yao

doi:10.1016/j.diabres.2022.110134

Cited by 6 publications

(7 citation statements)

References 41 publications

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Section: Discussionmentioning

confidence: 99%

“…Dialysis is proven as a strong risk factor for foot ulceration and amputation in patients with diabetes, and DFUs in this subgroup are usually concomitantly markedly impaired with limb perfusion and poor healing due to vascular calcification and uremic toxicity. 27 , 28 The predictors for treatment of patients with dialysis are different vis‐à‐vis those without dialysis. 29 This study revealed none of these wound classifications could predict prognosis alone in patients with dialysis; alternatively, serum levels of CRP and albumin are acknowledged as substantial risk factors of poor outcomes 30 , 31 in the population.…”

Section: Discussionmentioning

confidence: 99%

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Are current wound classifications valid for predicting prognosis in people treated for limb‐threatening diabetic foot ulcers?

Chang

Huang

Hung

et al. 2023

International Wound Journal

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This study aims to investigate whether the current wound classifications were valid for the treatment prognosis of subjects treated for limb‐threatening diabetic foot ulcers (LTDFU). A total of 1548 patients with LTDFU and infection were studied, with wounds recorded using the Wagner, Texas, PEDIS and WIfI classifications while major lower extremity amputations (LEAs) or in‐hospital mortality incidences were defined as poor outcomes. Among them, 153 (9.9%) patients received major LEAs and 38 (2.5%) patients died. After adjustments, the Wagner classification and Texas stage as well as clinical factors such as comorbidity with major adverse cardiac events (MACE), being under dialysis and having serum levels of C‐reactive protein (CRP) and albumin were independent factors for prognosis. For patients without dialysis, Wagner and Texas stage stood out independently for prognosis. For patients on dialysis, only levels of CRP (odds ratio [OR] = 2.2 in Wagner, OR = 2.0 in WIfI, OR = 2.2 in Texas, OR = 2.3 in PEDIS) and albumin (OR = 0.4 in four classifications) were valid predictors. The Wagner system and Texas stage were valid for predicting prognosis in treatment for LTDFUs, suggesting a role of vascular perfusion. MACE history, levels of CRP and albumin level should assist in prediction; more significantly, only levels of CRP and albumin appeared valid for those subjects undergoing dialysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Are current wound classifications valid for predicting prognosis in people treated for limb‐threatening diabetic foot ulcers?

Chang

Huang

Hung

et al. 2023

International Wound Journal

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“… 6 , 7 In one study, patients with kidney failure accounted for nearly one-third of amputations within the overall diabetes population. 8 …”

Section: Introductionmentioning

confidence: 99%

“…In addition, the impact of diabetic foot complications extends to health care use, with DFUs the leading cause of hospitalizations among patients with kidney failure. 8 , 11 Collectively, the cost of annual cost of DFU care to Medicare is estimated to be $9 billion, and the cost to private insurers is $1.3 billion. 15 …”

Section: Introductionmentioning

confidence: 99%

“…6,7 In one study, patients with kidney failure accounted for nearly one-third of amputations within the overall diabetes population. 8 Among the population of patients with kidney failure, approximately 10% to 32% of those receiving hemodialysis have active DFUs, while 22% to 41% have had a history of such ulcers. 9,10 The severity of kidney disease corresponds to DFU outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Foot and Ankle Care by Podiatrists and Amputations in Patients With Diabetes and Kidney Failure

Tan,

Caldwell,

Zhang

et al. 2024

JAMA Netw Open

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ImportancePatients with kidney failure have an increased risk of diabetes-related foot complications. The benefit of regular foot and ankle care in this at-risk population is unknown.ObjectiveTo investigate foot and ankle care by podiatrists and the outcomes of diabetic foot ulcers (DFUs) in patients with kidney failure.Design, Setting, and ParticipantsThis retrospective cohort study included Medicare beneficiaries with type 2 diabetes receiving dialysis who had a new DFU diagnosis. The analysis of the calendar year 2016 to 2019 data from the United States Renal Data System was performed on June 15, 2023, with subsequent updates on December 11, 2023.ExposuresFoot and ankle care by podiatrists during 3 months prior to DFU diagnosis.Main Outcomes and MeasuresThe outcomes were a composite of death and/or major amputation, as well as major amputation alone. Kaplan-Meier analysis was used to estimate 2 to 3 years of amputation-free survival. Foot and ankle care by podiatrists and the composite outcome was examined using inverse probability-weighted Cox regression, while competing risk regression models were used for the analysis of amputation alone.ResultsAmong the 14 935 adult patients with kidney failure and a new DFU (mean [SD] age, 59.3 [12.7] years; 35.4% aged ≥65 years; 8284 men [55.4%]; Asian, 2.7%; Black/African American, 35.0%; Hispanic, 17.7%; White, 58.5%), 18.4% (n = 2736) received care by podiatrists in the 3 months before index DFU diagnosis. These patients were older, more likely to be male, and have more comorbidities than those without prior podiatrist visits. Over a mean (SD) 13.5 (12.0)-month follow-up, 70% of those with podiatric care experienced death and/or major amputation, compared with 74% in the nonpodiatric group. Survival probabilities at 36 months were 26.3% vs 22.8% (P &lt; .001, unadjusted Kaplan-Meier survival analysis). In multivariate regression analysis, foot and ankle care was associated with an 11% lower likelihood of death and/or amputation (hazard ratio [HR], 0.89 95% CI, 0.84-0.93) and a 9% lower likelihood of major amputation (above or below knee) (HR, 0.91; 95% CI, 0.84-0.99) than those who did not.Conclusions and RelevanceThe findings of this study suggest that patients with kidney failure at risk for DFUs who receive foot and ankle care from podiatrists may be associated with a reduced likelihood of diabetes-related amputations.

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Retrospective cohort study on the safety and efficacy of paclitaxel-coated balloon in the treatment of diabetic subpatellar artery disease

Lin,

Chen,

Liu

et al. 2024

Medicine

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Paclitaxel can inhibit smooth muscle cell proliferation and migration, and reduce the risk of vascular restenosis after balloon dilation. Our study investigated the safety and efficacy of paclitaxel-coated balloon (PCB) treatment for diabetic subpatellar artery disease. In this study, 140 patients with diabetic subknee arterial disease treated in our hospital from January 2022 to December 2023 were selected as the study objects, and were divided into the control group (conventional balloon interventionization angioplasty) and the observation group (PCB interventionization angioplasty), with 70 cases in each group according to the differences in previous balloon interventionization. The safety and efficacy of the 2 treatments were compared. There was no significant difference in the primary patency rate 6 months after operation between the 2 groups (P > .05). There was significant difference in restenosis rate at 12 months after operation (P < .05). There was no significant difference in ankle–brachial index between the 2 groups before and 6 months after operation (P > .05). At 12 months after operation, ankle–brachial index of observation group was higher than that of control group, and the differences were statistically significant (P < .05). The improvement rate of walking impairment and 6 minutes walking distance in the observation group were significantly better than those in the control group, the difference was statistically significant (P < .05). There was no significant difference in the occurrence of adverse events between the 2 groups after operation (P > .05). For diabetic patients with subknee arterial disease, PCB treatment can ensure safety and improve clinical symptoms, and has good practical value.

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Diabetic foot disease in subjects with End-stage renal Disease: A nationwide study over 14 years highlighting an emerging threat

Cited by 6 publications

References 41 publications

Are current wound classifications valid for predicting prognosis in people treated for limb‐threatening diabetic foot ulcers?

Are current wound classifications valid for predicting prognosis in people treated for limb‐threatening diabetic foot ulcers?

Foot and Ankle Care by Podiatrists and Amputations in Patients With Diabetes and Kidney Failure

Retrospective cohort study on the safety and efficacy of paclitaxel-coated balloon in the treatment of diabetic subpatellar artery disease

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