Worse Than Cancer? Up to 74% of people on dialysis will die within two years after amputation

These sobering data from Agbor Ndip, Andrew Boulton and colleagues give us significant cause for pause at this years’ American Diabetes Association Symposium.

Abstract: Diabetes is the commonest cause of end-stage renal disease (ESRD), requiring renal replacement therapy. Lower extremity complications in diabetes can result in significant morbidity and mortality further compounding the poor survival of the dialysis population.
A prospective observational study involving diabetic patients with ESRD on dialysis was undertaken to evaluate the impact of foot ulcers and amputations on mortality. We studied 192 diabetic patients receiving dialysis at the Manchester Royal Infirmary, UK. These included 17 (8.9%) African-Caribbeans, 38 (19.8%) Indo-Asians and 137 (71.4%) White Europeans aged (mean ± SD) 59 ± 14 years, with a male/female ratio of 121/71. Comprehensive foot assessment was performed at baseline including evaluating for neuropathy, peripheral arterial disease, foot deformities, and foot ulcers/amputation. Patients were followed up for a two-year period. Overall mortality at the end of two years was high (102/192, 53.1%). Patients who had a foot ulcer at baseline (35/59, 59.3%) had a higher mortality after 2 years of follow-up, compared with patients without (55/133, 41.4%, p = 0.028). Similarly, patients who had had an amputation at baseline had higher mortality at 2 years (26/35, 74.3%) compared to patients without amputation (64/157, 40.8%, p < 0.0001).
These data highlight the excess mortality in dialysis-treated diabetic patients resulting from foot ulcers and amputations, therefore underpinning the importance of integrating foot care and amputation prevention within the dialysis population.

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