High Rates of Lower Limb Amputation in Patients with Diabetes End Stage Renal Failure on Hemodialysis: Is There a Causal Factor?

Program: Abstracts - Orals, Poster Preview Presentations, and Posters
Session: MON 1043-1072-Obesity, Diabetes, and Cardiovascular Risk
Monday, June 23, 2014: 1:00 PM-3:00 PM
Hall F (McCormick Place West Building)

Poster Board MON-1055
Rajit Aziz Gilhotra1, Beverly Terezinha Rodrigues1, Usman H Malabu, MD, FRACP, FACP.2, Venkat Vanagaveti1, George Kan2 and Kunwarjit Singh Sangla, MBBS, MD, FRACP2
1James Cook University, Douglas, Australia, 2The Townsville Hospital, Douglas, Australia
Hemodialysis has recently been identified as a risk factor for lower limb amputations (1,2). In spite of this no study has been published that analyses the magnitude and risk factors for amputation amongst hemodialysis patients in rural and remote communities and Indigenous Australian residents of the Tropical Northern region where diabetes and kidney disease are quite common (3). The objectives of this study were to document trends in prevalence and identify risk factors of non-traumatic lower limb amputations in diabetes subjects treated with hemodialysis in the region. 155 current haemodialysis patients attending the Townsville Dialysis Centre were included in the study. Odds ratio and χ2 tests were performed to identify variables most strongly associated with amputation. We identified a 13.6% prevalence of lower limb amputation in 155 subjects on hemodialysis at our centre. The major risk factors of amputations in the cohort were history of ulceration (RR 24.74 [95%CI 6.02-101.76] p<0.0001) and the presence of diabetes (RR 23.19 [95%CI 1.43-375.49] p=0.027). Other variables tested but fell short of statistical significance included: Indigenous background, smoking history, gender and type of ulceration. Thus, patients with end stage renal failure on hemodialysis who have a past history of ulceration and have diabetes mellitus are at higher risk of having lower limb amputation. Primary prevention of diabetes in the sub-population may help in reducing the limb loss. In-depth analysis of the data will be presented at the conference.

(1) O’Hare AM, Bacchetti P, Segal M, Hsu CY, Johansen KL, Dialysis M, et al. Factors associated with future amputation among patients undergoing hemodialysis. American journal of kidney diseases 2003;41:162-70. (2) Ndip A, Rutter MK, Vileikyte L, Vardhan A, Asari A, Jameel M, et al. Dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and stage 4 or 5 chronic kidney disease. Diabetes care. 2010;33:1811-6 (3) Malabu UH, Manickam V, Kan G, Doherty SL, Sangla KS. Calcific uremic arteriolopathy on multimodal combination therapy: still unmet goal. International journal of nephrology. 2012;2012:390768.

Nothing to Disclose: RAG, BTR, UHM, VV, GK, KSS

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