Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/22174
Title: Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: a prospective observational cohort study.
Austin Authors: Kaminski, Michelle R;Lambert, Katrina A;Raspovic, Anita;McMahon, Lawrence P;Erbas, Bircan;Mount, Peter F ;Kerr, Peter G;Landorf, Karl B
Affiliation: Discipline of Podiatry, School of Allied Health, Health Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
Department of Nephrology, Austin Health, Heidelberg, Victoria, Australia
Department of Public Health, School of Psychology and Public Health, La Trobe University, Victoria, 3086, Australia
University of Melbourne, Heidelberg, Victoria, Australia
Discipline of Podiatry, School of Allied Health, Health Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
Departments of Renal Medicine & Obstetric Medicine, Eastern Health Clinical School, Monash University, Melbourne, Victoria, 3128, Australia
Department of Public Health, School of Psychology and Public Health, La Trobe University, Victoria, 3086, Australia
Department of Nephrology, Monash Health, Melbourne, Victoria, 3168, Australia
Discipline of Podiatry, School of Allied Health, Health Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Health Services and Sport, La Trobe University, Victoria, 3086, Australia
Issue Date: 21-Nov-2019
metadata.dc.date: 2019-11-21
Publication information: BMC Nephrology 2019; 20(1): 423
Abstract: Dialysis patients experience high rates of foot ulceration. Although risk factors for ulceration have been extensively studied in patients with diabetes, there is limited high-quality, longitudinal evidence in the dialysis population. Therefore, this study investigated risk factors for foot ulceration in a stable dialysis cohort. We prospectively collected clinical, demographic, health status, and foot examination information on 450 adults with end-stage renal disease from satellite and home-therapy dialysis units in Melbourne, Australia over 12 months. The primary outcome was foot ulceration. Cox proportional hazard modelling and multinomial regression were used to investigate risk factors. Among 450 dialysis patients (mean age, 67.5 years; 64.7% male; 94% hemodialysis; 50.2% diabetes), new cases of foot ulceration were identified in 81 (18%) participants. Overall, risk factors for foot ulceration were neuropathy (HR 3.02; 95% CI 1.48 to 6.15) and previous ulceration (HR 2.86; CI 1.53 to 5.34). In those without history of ulceration, nail pathology (RR 3.85; CI 1.08 to 13.75) and neuropathy (RR 2.66; CI 1.04 to 6.82) were risk factors. In those with history of ulceration, neuropathy (RR 11.23; CI 3.16 to 39.87), peripheral arterial disease (RR 7.15; CI 2.24 to 22.82) and cerebrovascular disease (RR 2.08; CI 1.04 to 4.16) were risk factors. There were 12 (2.7%) new amputations, 96 (21.3%) infections, 24 (5.3%) revascularizations, 42 (9.3%) foot-related hospitalizations, and 52 (11.6%) deaths. Neuropathy and previous ulceration are major risk factors for foot ulceration in dialysis patients. Risk factors differ between those with and without prior ulceration. The risk factors identified will help to reduce the incidence of ulceration and its associated complications.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22174
DOI: 10.1186/s12882-019-1594-5
ORCID: 0000-0002-1133-4853
0000-0001-7637-3661
PubMed URL: 31752749
Type: Journal Article
Subjects: Amputation
Chronic kidney failure
Dialysis
Foot ulcer
Risk factors
Appears in Collections:Journal articles

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