Medial Arterial Calcification and the Risk of Amputation of Diabetic Foot Ulcer in Patients With Diabetic Kidney Disease

So, Joon Myeong; Park, Ji Ho; Kim, Jin Gyeong; Park, Il Rae; Ha, Eun Yeong; Chung, Seung Min; Moon, Jun Sung; Park, Chul-Hyun; Yun, Woo‐Sung; Kim, Tae-Gon; Kim, Ung; Yoon, Ji Sung; Won, Kyu Chang; Lee, Hyoung Woo

doi:10.3346/jkms.2023.38.e160

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…The severity of MAC was found to be associated with major limb adverse events in subjects undergoing angioplasty with a low wound grade, as demonstrated by Skolnik and colleagues study 18 . Furthermore, in the population with CKD, severe MAC was shown to exacerbate the limb outcomes of DFUs 16 . The findings of our study have extended the existing evidence linking pedal MAC and amputation in patients with severe limb ischemia and CKD to include patients with DFUs.…”

Section: Discussionsupporting

confidence: 77%

“… 18 Furthermore, in the population with CKD, severe MAC was shown to exacerbate the limb outcomes of DFUs. 16 The findings of our study have extended the existing evidence linking pedal MAC and amputation in patients with severe limb ischemia and CKD to include patients with DFUs. Furthermore, we have reinforced the notion that pedal MAC can exacerbate the negative outcomes for individuals with PAD.…”

Section: Discussionsupporting

confidence: 53%

“…In the studies conducted by Vartanian and colleagues, it was observed that the MAC score of the foot exhibited a significant association with both major amputation 14 and hemodynamic alterations following revascularization in individuals with chronic limb‐threatening ischemia 15 . In a recent study, So and colleagues conducted an assessment of the DFU characteristics in individuals with stages 3b–5 chronic kidney disease (CKD) and also investigated the associated risk of major amputation 16 . They discovered that the presence of severe MAC significantly increased the likelihood of major amputation (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.43–13.88; p = .010) within the CKD population.…”

Section: Introductionmentioning

confidence: 99%

“… 15 In a recent study, So and colleagues conducted an assessment of the DFU characteristics in individuals with stages 3b–5 chronic kidney disease (CKD) and also investigated the associated risk of major amputation. 16 They discovered that the presence of severe MAC significantly increased the likelihood of major amputation (odds ratio [OR], 4.46; 95% confidence interval [CI], 1.43–13.88; p = .010) within the CKD population.…”

Section: Introductionmentioning

confidence: 99%

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Pedal medial arterial calcification in diabetic foot ulcers: A significant risk factor of amputation and mortality

Chen,

Gong

et al. 2024

Journal of Diabetes

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AimsPedal medial arterial calcification (MAC) is frequently observed in individuals with diabetic foot ulcers (DFUs). However, the impact of pedal MAC on individuals with DFUs remains uncertain. The main aim of this study was to evaluate the association between pedal MAC with amputation and mortality outcomes.MethodsA prospective, observational cohort study was conducted at West China Hospital from January 2012 to December 2021. Logistic regression analyses, Kaplan–Meier survival method, and Cox proportional hazards models were employed to evaluate the relationship between pedal MAC and amputation as well as mortality.ResultsA total of 979 patients were enrolled in the study. Peripheral artery disease (PAD) was observed in 53% of patients with DFUs, and pedal MAC was found in 8%. Over a median follow‐up of 46 (23–72) months, foot amputation was performed on 190 patients, and mortality occurred in 246 patients. Pedal MAC showed a significant association with amputation both in unadjusted analysis (odds ratio [OR] = 2.98, 95% confidence interval [CI] = 1.86–4.76, p < .001) and after adjusting sex, age, albumin levels, hemoglobin levels, and diabetic retinopathy status (OR 2.29, 95% CI 1.33–3.93, p = .003). The risk of amputation was found to be twofold higher in individuals with PAD and pedal MAC compared to those with PAD alone (OR 2.05, 95% CI 1.10–3.82, p = .024). Furthermore, the presence of pedal MAC was significantly associated with an increased risk of mortality (p = .005), particularly among individuals with DFUs but without PAD (HR 4.26, 95% CI 1.90–9.52, p < .001), rather than in individuals presenting with both DFUs and PAD.ConclusionThe presence of pedal MAC is significantly associated with both amputation and mortality in individuals with DFUs. Moreover, pedal MAC could provide additional value to predict amputation other than PAD.image

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pedal medial arterial calcification in diabetic foot ulcers: A significant risk factor of amputation and mortality

Chen,

Gong

et al. 2024

Journal of Diabetes

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Associations of phosphorus concentrations with medial arterial calcification in lower-extremity arteries and diabetic foot in people with diabetes: a retrospective cross-sectional study

Li,

Tang

et al. 2024

Cardiovasc Diabetol

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Background The aim of this study was to investigate the associations of blood phosphorus levels with the risk of developing medial arterial calcification (MAC) in lower-limb arteries and diabetic foot (DF) in diabetes patients. We sought to enhance the understanding of the pathophysiology of diabetic complications and develop strategies to mitigate diabetes-related risks. Methods We conducted a retrospective analysis of 701 diabetic patients from the Department of Endocrinology at Sun Yat-Sen Memorial Hospital (2019–2023). We utilized multimodel-adjusted logistic regression to investigate the associations of serum phosphorus levels and the risk of developing MAC and DF. Restricted cubic spline plots were employed to model the relationships, and threshold analysis was used to identify inflection points. Subgroup analyses were performed to explore variations across different demographics. The diagnostic utility of phosphorus concentrations was assessed via the C index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Of the 701 patients (mean age 63.9 years; 401 (57.20%) were male), 333 (47.50%) had MAC, and 329 (46.93%) had DF. After controlling for numerous confounding variables, each one-unit increase in phosphorus concentrations was associated with an increased risk of developing MAC (OR 2.65, 95% CI 1.97–3.57, p < 0.001) and DF (OR 1.54, 95% CI 1.09–2.18, p = 0.014). Phosphorus levels demonstrated a linear risk association, with risk not being uniform on either side of the inflection point, which was approximately 3.28 mg/dL for MAC and varied for DF (3.26 to 3.81 mg/dL). Adding the phosphorus as an independent component to the diagnostic model for MAC and DF increased the C index, NRI, and IDI to varying degrees. Conclusions Elevated serum phosphorus levels are significantly associated with an increased risk of developing MAC and DF among diabetic people. These findings suggest that phosphorus management could be integrated into routine diagnostic processes to improve the identification and management of lower-extremity diabetic complications. Graphical abstract

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Medial Arterial Calcification and the Risk of Amputation of Diabetic Foot Ulcer in Patients With Diabetic Kidney Disease

Cited by 2 publications

References 25 publications

Pedal medial arterial calcification in diabetic foot ulcers: A significant risk factor of amputation and mortality

Pedal medial arterial calcification in diabetic foot ulcers: A significant risk factor of amputation and mortality

Associations of phosphorus concentrations with medial arterial calcification in lower-extremity arteries and diabetic foot in people with diabetes: a retrospective cross-sectional study

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