CKD Patients with Diabetes at All Stages at higher Risk of Lower Extremity Amputation, suggests study

"Patients with CKD stage 5 and diabetes were 30 times more likely to undergo a lower extremity amputation compared to those with CKD stage 5 but without diabetes," the researchers wrote in the Journal of Diabetes and its Complications.

Chronic kidney disease, a condition marked by the gradual loss of kidney function, often coexists with other serious health issues, particularly diabetes. Diabetes mellitus is known to contribute to a range of complications, including neuropathy, poor circulation, and infections, all of which can increase the likelihood of amputation. In CKD patients, these factors are compounded by impaired kidney function, which can hinder the body's ability to fight infections and heal wounds.

Lower extremity amputation is a severe and often dreaded complication of DM. In light of this, Dhruv Nandakumar, University of Texas Southwestern Medical School, Dallas, TX, USA, and colleagues sought to assess how DM influences LEA rates in patients across different stages of chronic kidney disease.

For this purpose, the researchers analyzed a commercially available de-identified database, reviewing data from 2010 to 2023 to identify patients undergoing lower extremity amputation and those diagnosed with CKD. The study included patients with and without diabetes who were followed for at least five years. LEA rates were then compared across all five stages of CKD between patients with diabetes and those without.

Key Findings:

• Higher LEA Rates for Diabetic Patients:
• Patients with diabetes exhibited significantly higher rates of all types of lower extremity amputation (LEA) across all stages of CKD, including overall, minor, and major LEA, compared to those without diabetes.
• Increased Risk in CKD Stage 5:
  • Patients with DM and CKD stage 5 (end-stage renal disease) were 30 times more likely to undergo any LEA compared to those without diabetes at CKD stage 5 (OR 30.2).
  • The likelihood of undergoing minor LEA in DM patients with CKD stage 5 was 29 times higher than in non-diabetic CKD stage 5 patients (OR 28.9).
  • Diabetic patients with CKD stage 5 had a 40 times greater risk of requiring major LEA compared to their non-diabetic counterparts (OR 40.1).
• Minor LEA More Common than Major LEA:
• Across all CKD stages, minor LEAs were more frequently performed than major LEAs, regardless of diabetes status.
• LEA Rates Increase with CKD Progression in Diabetic Patients:
• In patients with diabetes, LEA rates significantly increased as CKD progressed from stages 2 to 5, with a notable surge between stages 4 and 5 (OR 2.6).
• No Significant LEA Increase Between CKD Stages 1 and 2
  :
• For patients with diabetes, there was no significant increase in LEA rates between CKD stages 1 and 2 (OR 1.1).

"To our knowledge, this study represents the first large retrospective database analysis comparing lower extremity amputation rates in patients with CKD, both with and without diabetes," the researchers wrote.

"The findings indicate that patients with diabetes face a significantly higher risk of LEA at all stages of CKD. Foot and ankle surgeons managing diabetes-related foot conditions should be aware of the potential impact of declining renal function on these patients' outcomes. These results warrant further investigation to confirm and expand upon the observed trends," they concluded.

Reference:

Nandakumar, D., Johnson, M. J., Lavery, L. A., Conover, B. M., Raspovic, K. M., Truong, D. H., & Wukich, D. K. (2024). Lower extremity amputation rates in patients with chronic kidney disease: A database study comparing patients with and without diabetes mellitus. Journal of Diabetes and its Complications, 38(11), 108876. https://doi.org/10.1016/j.jdiacomp.2024.108876