Enfermedad arterial periférica y pié diabético en pacientes en programa de hemodiálisis

Viejo, Azucena García

doi:10.4321/s2254-28842012000400003

Cited by 4 publications

(1 citation statement)

References 13 publications

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“…Despite the high prevalence of foot ulceration in the dialysis population, there is a paucity of high‐quality prospective studies that have investigated the risk factors associated with this condition. Existing risk factor studies [5, 6, 8–10, 12, 82–88] have been limited by small sample sizes, inadequate control for confounding variables, do not encompass a full range of risk factors, and the majority are either cross‐sectional or retrospective. Moreover, these study designs do not examine for a temporal sequence of events, so it is difficult to conclude whether these risk factors are associated with an increase in foot ulceration.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for foot ulceration in adults with end‐stage renal disease on dialysis: study protocol for a prospective observational cohort study

Kaminski

Raspovic

McMahon

et al. 2015

Journal of Foot and Ankle Research

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BackgroundAdults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation. However, the risk factors for foot ulceration in the dialysis population are incompletely understood due to the lack of high-quality prospective evidence. This article outlines the design of a prospective observational cohort study, which aims to investigate the risk factors for foot ulceration in adults on dialysis.Methods/DesignThis study will recruit 430 participants with end-stage renal disease on dialysis from satellite and home-therapy dialysis units across multiple health organisations in Melbourne, Victoria, Australia. Data collection at baseline will include a participant interview, medical record review, completion of a health-status questionnaire and a non-invasive foot assessment. Twenty participants will also be recruited to a reliability study to evaluate the reproducibility of testing procedures. Primary outcome data includes: new foot ulcer(s). Secondary outcome data includes: number of new foot ulcers, time to onset of new foot ulcer(s), new lower extremity amputation(s), episodes of infection of the foot or lower extremity, episodes of osteomyelitis, foot-related hospitalisations, revascularisation procedure(s) of the lower extremity, new podiatry interventions, kidney transplantation, and mortality. Participants will be assessed at baseline, and at 12 months they will be evaluated for the primary and secondary outcomes. Multivariate Cox proportional hazards models will be used to assess predictors of new foot ulceration and time to event secondary outcomes. Logistic regression will be used for binary outcomes including prevalence of foot ulcerations.DiscussionThis is the first multi-centre prospective observational cohort study to investigate risk factors for foot ulceration in adults with end-stage renal disease on dialysis. This study will improve on prior studies by using prospective methods, multi-centre recruitment, statistical methods to control for confounding variables, and a pre-specified sample size estimation. The findings can inform the design of future trials evaluating the effectiveness of clinical interventions, which may lead to improved patient outcomes in the dialysis setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0110-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Risk factors for foot ulceration in adults with end‐stage renal disease on dialysis: study protocol for a prospective observational cohort study

Kaminski

Raspovic

McMahon

et al. 2015

Journal of Foot and Ankle Research

View full text Add to dashboard Cite

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Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on dialysis: a systematic review and meta-analysis

Kaminski

Raspovic

McMahon

et al. 2015

Nephrol. Dial. Transplant.

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Dialysis patients who have markedly higher risks of ulceration or amputation include those with previous foot ulceration or amputation, peripheral neuropathy, diabetes or macrovascular disease. The temporal relationship between these risk factors and the development of foot ulceration and/or limb loss is uncertain and requires further study. Stable estimates of the key risk factors for ulceration and amputation can inform the design of future trials investigating clinical interventions to reduce the burden of lower limb disease in the dialysis population.

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Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study

et al. 2017

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BackgroundAdults on dialysis are at increased risk of foot ulceration, which commonly precedes more serious lower limb complications, including amputation. Limited data exist regarding the prevalence and factors associated with foot disease in this population. Hence, this study set out to investigate factors associated with foot ulceration and amputation in a dialysis cohort.MethodsThis study presents a cross-sectional analysis of baseline data from a multi-center prospective cohort study. We recruited 450 adults with end-stage renal disease on dialysis from multiple satellite and home-therapy dialysis units in Melbourne, Australia from January to December 2014. Data collection consisted of a participant interview, medical record review, health-status questionnaire and non-invasive foot examination. Logistic regression analyses were conducted to evaluate associations between screened variables and study outcomes.ResultsMean age was 67.5 (SD, 13.2) years, 64.7% were male, 94% were on hemodialysis, median dialysis duration was 36.9 (IQR, 16.6 to 70.1) months, and 50.2% had diabetes. There was a high prevalence of previous ulceration (21.6%) and amputation (10.2%), 10% had current foot ulceration, and 50% had neuropathy and/or peripheral arterial disease. Factors associated with foot ulceration were previous amputation (OR, 10.19), peripheral arterial disease (OR, 6.16) and serum albumin (OR, 0.87); whereas previous and/or current ulceration (OR, 167.24 and 7.49, respectively) and foot deformity (OR, 15.28) were associated with amputation.ConclusionsDialysis patients have a high burden of lower limb complications. There are markedly higher risks of foot ulceration and/or amputation in those with previous and/or current ulceration, previous amputation, peripheral arterial disease, lower serum albumin, and foot deformity. Although not a major risk factor, diabetes in men was an important effect modifier for risk of ulceration.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0711-6) contains supplementary material, which is available to authorized users.

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Enfermedad arterial periférica y pié diabético en pacientes en programa de hemodiálisis

Cited by 4 publications

References 13 publications

Risk factors for foot ulceration in adults with end‐stage renal disease on dialysis: study protocol for a prospective observational cohort study

Risk factors for foot ulceration in adults with end‐stage renal disease on dialysis: study protocol for a prospective observational cohort study

Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on dialysis: a systematic review and meta-analysis

Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study

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