Biomarkers of Chronic Kidney Disease-Mineral Bone Disorder (CKD-MBD) in the Diabetic Foot: A Medical Record Review

Make the link between chronic kidney disease, pedal calcification…and even Charcot? This from our SALSAmigos at Washington University, St. Louis.

Aims: Determine the prevalence and relative risk of having single and combinations of biomarkers of chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome in the diabetic foot from an electronic medical record (EMR) review.

Methods: Review of 152 patients with one foot radiograph and diagnoses of both diabetes mellitus (DM) and chronic kidney disease (CKD) stages 1-5. Presence/absence of peripheral neuropathy (PN), targeted serum markers, and both pedal vessel calcification (PVC) and buckling ratio (BR) of 2nd and 5th metatarsals from radiographs were recorded. Prevalence of single and combinations of foot biomarkers are reported as count and percentage. Risk ratios (RR) with 95% confidence intervals (95% CI) were calculated to assess risk of foot biomarkers in each stage of CKD-MBD.

Results: Prevalence and RR of PVC, PN, and BR ≥ 3.5 biomarkers, both single and in combination, all increase with progression of CKD. The RR increases to 9.6 (95% CI: 3, 26; p<0.001)) when all 3 biomarkers present in stage 5.

Conclusions: PVC, PN, and BR ≥ 3.5 are prognostic biomarkers of CKD-MBD syndrome in the diabetic foot. Recognition of these foot biomarkers may allow earlier interventions to help reduce nontraumatic lower extremity amputation in individuals with diabetic CKD-MBD.

Keywords: Amputation; Chronic Kidney Disease Mineral Bone Disorder; Diabetic Foot; Diabetic Neuropathies; Peripheral Arterial Disease.

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