Diabetic foot disease in subjects with End-stage renal Disease: A nationwide study over 14 years highlighting an emerging threat
- Cheng-Wei Lin
- David G. Armstrong
- Chung-Huei Huang
- Shih-Yuan Hung
- Pi-Hua Liu 1
- Yu-Yao Huang 1
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Open AccessPublished:October 28, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110134
- •This nationwide study revealed annual prevalence of subjects with end-stage renal disease (ESRD) has increased some 3.9-fold over 14 years.
- •These ESRD patients now account for approximately 30% of annual major-LEA of the total diabetic foot disease (DFD) population.
- •Peripheral arterial disease was the major difference of foot presentation compared to those of without ESRD.
- •The increase of endovascular treatments (EVTs) was associated with a reduction in rate of limb loss.
- •People with diabetes and ESRD should be educated to prevent foot ulcers and the interdisciplinary team approach is indicated if DFD complicated.
To disclose prevalence, demographic, foot characteristics as well as management and lower-extremity amputations (LEAs) of subjects with end-stage renal disease (ESRD) on diabetic foot diseases (DFDs).
Data were derived from the Taiwan National Health Insurance Research Database between 2004 and 2017. DFDs were defined as ulcers, infections, or severe peripheral arterial diseases (PADs) in patients with type 2 diabetes. Clinical characteristics were analyzed between subjects with and without ESRD.
Subjects with ESRD have increased impacts on the DFD population either from annual prevalence (2.7 % to 10.42 %, P for trend < 0.001), or proportional representation in LEAs (7.91 % to 26.37 %, P < 0.001) over 14 years. The annual trends for major-LEAs rates have decreased in both subjects with and without ESRD (13.67 % to 5.82 % and 3.48 % to 1.47 %, both P < 0.001). Notably, the concomitant increase of endovascular treatments (EVTs) (7.09 % to 29.41 %, P < 0.001) was associated with the decrease of major-LEAs (P for interaction < 0.001) in subjects with ESRD.
As the annual prevalence of subjects with ESRD has increased 3.9-fold over years, they now account for more than 30% of annual major-LEA of the total DFD population. Interdisciplinary team approach and aggressive EVTs might reduce major-LEAs in these patients.