High Levels of Foot Ulceration and Amputation Risk in a Multiracial Cohort of Diabetic Patients on Dialysis Therapy

OBJECTIVE

To evaluate the prevalence of lower-limb complications in a multiracial cohort of patients with diabetes receiving dialysis.

RESEARCH DESIGN AND METHODS

This work was a cross-sectional study of lower-limb complications in dialysis-treated patients with diabetes in the U.K. and U.S.

RESULTS

We studied 466 patients (139 U.K.; 327 U.S.). The prevalence of lower-limb complications was high (foot ulcers 12%, neuropathy 79%, peripheral arterial disease 57%, history of foot ulceration 34%, and prior amputation 18%), with no significant ethnic variation, except that foot ulcers were more common in whites than in patients of African descent (P = 0.013). Ninety-five percent of patients were at high risk of lower-limb complications. Prior amputation was related to foot ulcer history, peripheral arterial disease, and hemodialysis modality in multivariable analysis. Prevalent ulceration showed independent associations with foot ulcer history and peripheral arterial disease, but not with ethnicity.

CONCLUSIONS

All patients with diabetes receiving dialysis are at high risk of lower-limb complications independent of ethnic background.Among individuals with diabetes, significant ethnic differences in lower-limb complications have been identified in the U.K. (1) and the U.S. (2). Previous studies linking renal impairment or end-stage renal disease to lower-limb complications have been retrospective and have not considered ethnicity (3,4). We aimed to establish the prevalence of lower-limb complications by ethnic group in dialysis-treated diabetic patients.