Impaired "Toemerular Filtration Rate" (TFR): A further risk factor for amputation

The clinician working in the area of the diabetic foot can’t help but being confronted with the complexities that renal disease adds to the healing and prevention equation. Many, if not most, of our complex patients on the SALSA service have added nephropathy. This has led us to coin the term “impaired Toemerular Filtration Rate” in our patient population. 

Two of our colleagues, Professors Andrew Boulton and Lawrence Lavery, from Manchester and Texas, respectively, are working now to quantify the effects of impaired “TFR”. We in Tucson eagerly look forward to their further findings. 

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  1. I would propose that the “TFR” is reduced in many patients with ESRD, not elevated. We have previously noted that bypass grafts in patients with ESRD frequently have increased resistance patterns on postoperative duplex ultrasound surveillance compared to non-diabetics and diabetics without ESRD. We hypothesize that this is due to anatomic, physiologic, or biochemical alterations in the outflow vessels in ESRD patients. Thus, despite a patent bypass, the limb salvage rate in ESRD patients is not as high as for non-ESRD patients – their outflow resistance is elevated, thus reducing their effective toemerular filtration rate (TFR). Unfortunately, we don’t yet have a dialysis equivalent for patients with reduced TFR.

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