Diabetic foot disease in patients with end-stage renal disease: An emerging threat?

"Over the years, the annual prevalence of patients with ESRD has increased 3.9-fold; they now constitute more than 30% of annual major-lower-extremity amputations (LEAs) of subjects with ESRD on diabetic foot diseases," Cheng-Wei Lin and colleagues from Taiwan wrote in their study published in Diabetes Research and Clinical Practice. "An interdisciplinary team approach and aggressive endovascular treatments (EVTs) might reduce major LEAs in these patients."

The study was conducted to disclose the prevalence, foot characteristics, demographic, and management and lower-extremity amputations of patients with end-stage renal disease on diabetic foot diseases.

For this purpose, the research team derived data from the Taiwan National Health Insurance Research Database from 2004 to 2017. Analysis of the clinical characteristics was done between subjects with and without ESRD. Diabetic foot ulcers were infections, ulcers, or severe peripheral arterial diseases in type 2 diabetes patients.

The study demonstrated the following findings:

· ESRD patients have increased impacts on the DFD population from annual prevalence (2.7% to 10.42%) or proportional representation in LEAs (7.91% to 26.37%) over 14 years.

· The annual trends for significant LEAs rates have decreased in patients with and without the end-stage renal disease (13.67% to 5.82% and 3.48% to 1.47%).

· The concurrent rise of endovascular treatments (EVTs) (7.09% to 29.41%) was associated with decreased prominent LEAs in patients with ESRD.

PAD was the significant difference in foot presentation versus those without ESRD. The increase in endovascular treatments was linked with reduced limb loss rates.

"Patients with diabetes and concomitant ESRD should be educated about DFD prevention, and the performance of endovascular treatments should not be hesitated if PAD is complicated," the researchers concluded.

Reference:

"Diabetic Foot Disease in Subjects with End-stage Renal Disease: A Nationwide Study over 14 Years Highlighting an Emerging Threat" was published in Diabetes Research and Clinical Practice.

DOI: https://doi.org/10.1016/j.diabres.2022.110134