Cargando…

Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study

BACKGROUND: Adults on dialysis are at increased risk of foot ulceration, which commonly precedes more serious lower limb complications, including amputation. Limited data exist regarding the prevalence and factors associated with foot disease in this population. Hence, this study set out to investig...

Descripción completa

Detalles Bibliográficos
Autores principales: Kaminski, Michelle R., Raspovic, Anita, McMahon, Lawrence P., Lambert, Katrina A., Erbas, Bircan, Mount, Peter F., Kerr, Peter G., Landorf, Karl B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591526/
https://www.ncbi.nlm.nih.gov/pubmed/28886703
http://dx.doi.org/10.1186/s12882-017-0711-6
_version_ 1783262731422400512
author Kaminski, Michelle R.
Raspovic, Anita
McMahon, Lawrence P.
Lambert, Katrina A.
Erbas, Bircan
Mount, Peter F.
Kerr, Peter G.
Landorf, Karl B.
author_facet Kaminski, Michelle R.
Raspovic, Anita
McMahon, Lawrence P.
Lambert, Katrina A.
Erbas, Bircan
Mount, Peter F.
Kerr, Peter G.
Landorf, Karl B.
author_sort Kaminski, Michelle R.
collection PubMed
description BACKGROUND: Adults on dialysis are at increased risk of foot ulceration, which commonly precedes more serious lower limb complications, including amputation. Limited data exist regarding the prevalence and factors associated with foot disease in this population. Hence, this study set out to investigate factors associated with foot ulceration and amputation in a dialysis cohort. METHODS: This study presents a cross-sectional analysis of baseline data from a multi-center prospective cohort study. We recruited 450 adults with end-stage renal disease on dialysis from multiple satellite and home-therapy dialysis units in Melbourne, Australia from January to December 2014. Data collection consisted of a participant interview, medical record review, health-status questionnaire and non-invasive foot examination. Logistic regression analyses were conducted to evaluate associations between screened variables and study outcomes. RESULTS: Mean age was 67.5 (SD, 13.2) years, 64.7% were male, 94% were on hemodialysis, median dialysis duration was 36.9 (IQR, 16.6 to 70.1) months, and 50.2% had diabetes. There was a high prevalence of previous ulceration (21.6%) and amputation (10.2%), 10% had current foot ulceration, and 50% had neuropathy and/or peripheral arterial disease. Factors associated with foot ulceration were previous amputation (OR, 10.19), peripheral arterial disease (OR, 6.16) and serum albumin (OR, 0.87); whereas previous and/or current ulceration (OR, 167.24 and 7.49, respectively) and foot deformity (OR, 15.28) were associated with amputation. CONCLUSIONS: Dialysis patients have a high burden of lower limb complications. There are markedly higher risks of foot ulceration and/or amputation in those with previous and/or current ulceration, previous amputation, peripheral arterial disease, lower serum albumin, and foot deformity. Although not a major risk factor, diabetes in men was an important effect modifier for risk of ulceration. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-017-0711-6) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-5591526
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-55915262017-09-13 Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study Kaminski, Michelle R. Raspovic, Anita McMahon, Lawrence P. Lambert, Katrina A. Erbas, Bircan Mount, Peter F. Kerr, Peter G. Landorf, Karl B. BMC Nephrol Research Article BACKGROUND: Adults on dialysis are at increased risk of foot ulceration, which commonly precedes more serious lower limb complications, including amputation. Limited data exist regarding the prevalence and factors associated with foot disease in this population. Hence, this study set out to investigate factors associated with foot ulceration and amputation in a dialysis cohort. METHODS: This study presents a cross-sectional analysis of baseline data from a multi-center prospective cohort study. We recruited 450 adults with end-stage renal disease on dialysis from multiple satellite and home-therapy dialysis units in Melbourne, Australia from January to December 2014. Data collection consisted of a participant interview, medical record review, health-status questionnaire and non-invasive foot examination. Logistic regression analyses were conducted to evaluate associations between screened variables and study outcomes. RESULTS: Mean age was 67.5 (SD, 13.2) years, 64.7% were male, 94% were on hemodialysis, median dialysis duration was 36.9 (IQR, 16.6 to 70.1) months, and 50.2% had diabetes. There was a high prevalence of previous ulceration (21.6%) and amputation (10.2%), 10% had current foot ulceration, and 50% had neuropathy and/or peripheral arterial disease. Factors associated with foot ulceration were previous amputation (OR, 10.19), peripheral arterial disease (OR, 6.16) and serum albumin (OR, 0.87); whereas previous and/or current ulceration (OR, 167.24 and 7.49, respectively) and foot deformity (OR, 15.28) were associated with amputation. CONCLUSIONS: Dialysis patients have a high burden of lower limb complications. There are markedly higher risks of foot ulceration and/or amputation in those with previous and/or current ulceration, previous amputation, peripheral arterial disease, lower serum albumin, and foot deformity. Although not a major risk factor, diabetes in men was an important effect modifier for risk of ulceration. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12882-017-0711-6) contains supplementary material, which is available to authorized users. BioMed Central 2017-09-08 /pmc/articles/PMC5591526/ /pubmed/28886703 http://dx.doi.org/10.1186/s12882-017-0711-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Kaminski, Michelle R.
Raspovic, Anita
McMahon, Lawrence P.
Lambert, Katrina A.
Erbas, Bircan
Mount, Peter F.
Kerr, Peter G.
Landorf, Karl B.
Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
title Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
title_full Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
title_fullStr Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
title_full_unstemmed Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
title_short Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
title_sort factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591526/
https://www.ncbi.nlm.nih.gov/pubmed/28886703
http://dx.doi.org/10.1186/s12882-017-0711-6
work_keys_str_mv AT kaminskimicheller factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT raspovicanita factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT mcmahonlawrencep factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT lambertkatrinaa factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT erbasbircan factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT mountpeterf factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT kerrpeterg factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy
AT landorfkarlb factorsassociatedwithfootulcerationandamputationinadultsondialysisacrosssectionalobservationalstudy