Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population

Eggers, Paul W.; Gohdes, Dorothy; Pugh, Jacqueline A.

doi:10.1046/j.1523-1755.1999.00668.x

Cited by 238 publications

(217 citation statements)

References 37 publications

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“…Recently, Karter et al (21) found that Asian patients with diabetes had 60% lower risk of lower-extremity amputation compared with whites in a large HMO population. Similarly, Eggers et al (15) found that Asian-American dialysis patients had the lowest amputation risk (OR ϭ 0.58, P Ͻ 0.0001) when compared with whites. Those results compare with the current study, in which a 70% reduction in risk of amputation was found that persisted despite the presence of renal disease.…”

Section: Statistical Analysesmentioning

confidence: 83%

“…Nationally, diabetes is associated with Ͼ65% of nontraumatic lowerextremity amputations performed, even though diabetic individuals account for Ͻ3% of the total U.S. population (1,2). Risk factors for amputations in individuals with diabetes include age (3-6), peripheral vascular disease (7-9), smoking (6,7,10,11), hypertension (6 -8,10,11), glycemic control (7,8,10,12,13), renal disease (7,9, 11,14,15), and race/ethnicity (3,4,6,9,11,12,(15)(16)(17)(18)(19)(20), although it remains controversial whether African Americans have an increased incidence of amputations (7,13,21). Conversely, most minority patients are at increased risk of lower-extremity amputations in the setting of end-stage renal disease (ESRD) (15); however, risk associated with renal disease before the initiation of dialysis has not been clearly established.…”

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confidence: 99%

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Effects of Ethnicity and Nephropathy on Lower-Extremity Amputation Risk Among Diabetic Veterans

et al. 2003

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OBJECTIVE -To describe ethnic differences in the risk of amputation in diabetic patients with diabetic nephropathy. RESEARCH DESIGN AND METHODS-A retrospective cohort study was conducted on a national cohort of diabetic patients who received primary care within the Veterans Affairs (VA) Health Care System. Hospitalizations for lower-limb amputations were established by ICD-9-CM procedure codes. Relative risk of amputation in diabetic patients with and without diabetic nephropathy was determined using Cox proportional hazard modeling for unadjusted and adjusted models.RESULTS -Of the 429,918 subjects identified with diabetes (mean age 64 Ϯ 11 years, 97.4% male), 3,289 individuals were determined to have had a lower-limb amputation during the study period. Compared with diabetic patients without amputations, amputees were on average older, more likely to belong to a minority group, and were more likely to have received treatment for more comorbid conditions. Asians were more likely to have toe amputations compared with whites or other ethnicities, while Native Americans were more likely to have below-the-knee amputations. Native Americans had the highest risk of amputation (RR 1.74, 95% CI 1.39 -2.18), followed by African Americans (RR 1.41, 95% CI 1.34 -1.48) and Hispanics (RR 1.28, 95% CI 1.20 -1.38) compared with whites. The presence of diabetic nephropathy increased the risk of amputation threefold in all groups. Asian subjects with diabetes had the lowest adjusted relative risk of amputation (RR 0.31, 95% CI 0.19 -0.50).CONCLUSIONS -Among diabetic patients, certain ethnic minority individuals have an increased risk of lower-extremity amputation compared with whites. Presence of diabetic nephropathy further increases this risk. Diabetes Care 26:495-501, 2003

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Section: Statistical Analysesmentioning

confidence: 83%

mentioning

confidence: 99%

Effects of Ethnicity and Nephropathy on Lower-Extremity Amputation Risk Among Diabetic Veterans

et al. 2003

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“…Conversely, patients on chronic dialysis have high atherosclerosis and arteriosclerosis rates [6]; the increased arterial stiffness is responsible for the high prevalence of carotid artery stenosis, myocardial infarction, PAD, and stroke in this population [6]. PAD is an atherosclerotic occlusive disease with/without vascular calcifications in the intima of lower extremity arteries [7][8][9]. The symptoms of PAD include intermittent claudication, which progresses to ischemic leg pain, critical limb ischemia, and finally, tissue necrosis requiring amputation.…”

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confidence: 99%

“…The symptoms of PAD include intermittent claudication, which progresses to ischemic leg pain, critical limb ischemia, and finally, tissue necrosis requiring amputation. The prevalence of PAD is high among patients with chronic kidney disease or end-stage renal disease [7][8][9]. Patients with end-stage renal disease have nearly 10-fold higher lower extremity amputation rates compared with the general population [8,9].…”

mentioning

confidence: 99%

“…The prevalence of PAD is high among patients with chronic kidney disease or end-stage renal disease [7][8][9]. Patients with end-stage renal disease have nearly 10-fold higher lower extremity amputation rates compared with the general population [8,9]. Cardiovascular disease is the leading cause of death in both chronic kidney disease and peritoneal dialysis/hemodialysis patients [10].…”

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confidence: 99%

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Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

et al. 2011

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Trends in Rates of Lower Extremity Amputation Among Patients With End-stage Renal Disease Who Receive Dialysis

et al. 2018

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IMPORTANCE Patients with end-stage renal disease (ESRD) who receive dialysis are at high risk of lower extremity amputation. Recent studies indicate decreasing rates of lower extremity amputation in non-ESRD populations, but contemporary data for patients with ESRD who receive dialysis are lacking. OBJECTIVES To assess rates of lower extremity amputation among patients with ESRD who receive dialysis during a recent 15-year period; to analyze whether those rates differed by age, sex, diabetes, or geographic region; and to determine 1-year mortality rates in this population after lower extremity amputation. DESIGN, SETTING, AND PARTICIPANTS This retrospective study of 3 700 902 records obtained from a US national registry of patients with ESRD who receive dialysis assessed cross-sectional cohorts for each calendar year from 2000 through 2014. Adult patients with prevalent ESRD treated with hemodialysis or peritoneal dialysis covered by Medicare Part A and B on January 1 of each cohort year were included. Data analysis was conducted from August 2017 to April 2018. EXPOSURES Age, sex, diabetes, and hospital referral region. MAIN OUTCOMES AND MEASURES Annual rates per 100 person-years of nontraumatic major (above-or below-knee) and minor (below-ankle) amputations.

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Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population

Abstract: The ESRD population is at an extremely high risk of lower limb amputation. Coordinated programs to screen for high-risk feet and to provide regular foot care for those at high risk combined with guidelines for treatment and referral of ulceration are needed.

Cited by 238 publications

References 37 publications

Effects of Ethnicity and Nephropathy on Lower-Extremity Amputation Risk Among Diabetic Veterans

Effects of Ethnicity and Nephropathy on Lower-Extremity Amputation Risk Among Diabetic Veterans

Screening for peripheral artery disease in dialysis patients: an opportunity for early disease detection and timely initiation of appropriate therapeutic measures

Trends in Rates of Lower Extremity Amputation Among Patients With End-stage Renal Disease Who Receive Dialysis

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