Vascular complications of the lower extremities in diabetic patients on peritoneal dialysis

Pliakogiannis, Theodoros; Bailey, Susan M.; Cherukuri, Shashidhar; Taşkapan, Hülya; Ahmad, Mufazzal; Oliver, T. H.; Bargman, Joanne M.; Dg, Oreopoulos

doi:10.5414/cnp69361

Cited by 20 publications

(16 citation statements)

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“…Anemia is highly prevalent in ESRD, resulting in reduced tissue oxygenation and impaired wound healing. A follow-up study of 71 diabetic patients on peritoneal dialysis found that those who had a foot complication (ulcer, gangrene, PAD, foot infection) were more likely to have low serum albumin and more likely to have received higher doses of erythropoietin [42], thus further underpinning the etiopathogenetic role of hypoalbuminemia and anemia in foot complications. Poor vision and reduced dexterity may impair an individual's ability to perform foot inspection or foot self-care.…”

Section: Other Risk Factors For Diabetic Foot Disease In Esrdmentioning

confidence: 98%

Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

2010

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Among the spectrum of risk for diabetic foot disease conferred by chronic kidney disease (CKD), end-stage renal disease (ESRD) has emerged as a novel independent risk factor. Apart from the classical triad of neuropathy, infection, and peripheral arterial disease that operate in these individuals, the risk is further compounded by inadequate foot self-care by patients and by dialysis centers not providing onsite foot care, as medical priorities are diverted to the dialysis itself. Consequently, the burden of diabetic foot disease has increased in the CKD and ESRD population as exemplified by high ulceration, amputation, and foot-related mortality rates. Current guidelines on foot care in diabetes should recognize advanced CKD and ESRD/dialysis as a separate risk factor for foot disease to alert professionals and highlight the opportunity for prevention. Recent studies have demonstrated improved foot outcomes when chiropody programs are instituted within dialysis units.

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Section: Other Risk Factors For Diabetic Foot Disease In Esrdmentioning

confidence: 98%

Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

2010

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“…Combes et al observed that while older age was associated with a decreased probability of amputation in diabetic HD patients, it actually increased the likelihood of amputation among non-diabetics [15]. Pilakogiannis et al reported that age is not related to developing PVD, but no further information is available about the association between age and amputation in PD patients [7]. The inconsistency of these results across studies likely reflects the diverse medical care and mortality rates of different renal populations.…”

Section: Discussionmentioning

confidence: 99%

“…O’Hare et al reported that hemodialysis (HD) patients who were male, diabetic, had been previously diagnosed with peripheral vascular disease (PVD), had high mean systolic blood pressure, or elevated phosphate levels had increased risks of future amputation [5]. Only a few studies have investigated the risk factors of amputation in peritoneal dialysis (PD) patients, and these have had limited sample size [6,7]. Pliakogiannis et al studied 71 diabetic patients receiving PD and noted that low levels of albumin, peripheral neuropathy, and coronary artery disease were associated with foot lesions [7].…”

Section: Introductionmentioning

confidence: 99%

“…Only a few studies have investigated the risk factors of amputation in peritoneal dialysis (PD) patients, and these have had limited sample size [6,7]. Pliakogiannis et al studied 71 diabetic patients receiving PD and noted that low levels of albumin, peripheral neuropathy, and coronary artery disease were associated with foot lesions [7]. In the clinic, we noted that PD patients who required hypertonic peritoneal dialysis (HPD) solution soon after the initiation of PD were more likely to require amputation.…”

Section: Introductionmentioning

confidence: 99%

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Early utilization of hypertonic peritoneal dialysate and subsequent risks of non-traumatic amputation among peritoneal dialysis patients: a nationwide retrospective longitudinal study

Lin

et al. 2013

BMC Nephrol

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BackgroundThe hemodialysis (HD) population has a particularly high incidence of amputation, which is likely associated with decreased tissue oxygenation during HD. However, information about the risk factors leading to amputation in peritoneal dialysis (PD) patients is limited. Here, we have investigated the association between the use of hypertonic peritoneal dialysate (HPD) and subsequent amputation in PD patients.MethodsBased on the data from the Taiwan National Health Insurance research database, this observational cohort study enrolled 203 PD patients who had received HPD early during treatment and had not undergone amputation and 296 PD controls who had not undergone amputation. Subjects were followed through until the end of 2009 and the event rates of new non-traumatic amputation were compared between groups.ResultsThe incidence of amputation was 3 times higher for the HPD cohort than for the comparison cohort (23.68 vs. 8.01 per 1000 person-years). The hazard ratio (HR) for this group, estimated using a multivariable Cox model, was 2.48 (95% confidence interval [CI] = 1.06–5.79). The HR for patients with both diabetes and early adoption of HPD increased to 44.34 (95% CI = 5.51-357.03), compared to non-HPD non-diabetic PD controls.ConclusionEarly utilization of HPD in PD patients is associated with increasing risk of amputation; this risk considerably increases for those with concomitant diabetes.

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“…Foot complications are more common in diabetic patients with ESRD,24 and in those undergoing dialysis 25. Diabetic patients are more likely to require amputation than non-diabetics on HD,26 are more likely to require more major amputation (below-knee or above-knee),27 and are more likely to die following amputation,28 percutaneous intervention29 or critical limb ischaemia 30. In diabetic subjects undergoing peritoneal dialysis (PD), the presence of foot complications is strongly associated with mortality 27…”

Section: What Effect Does Diabetes Have On Mortality and Morbidity Inmentioning

confidence: 99%

Managing diabetes in dialysis patients

O'Toole¹,

Fan²,

Yaqoob³

et al. 2012

Postgraduate Medical Journal

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Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with dietitians and podiatrists.

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Vascular complications of the lower extremities in diabetic patients on peritoneal dialysis

Cited by 20 publications

References 0 publications

Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

Early utilization of hypertonic peritoneal dialysate and subsequent risks of non-traumatic amputation among peritoneal dialysis patients: a nationwide retrospective longitudinal study

Managing diabetes in dialysis patients

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