Amputations and foot-related hospitalisations disproportionately affect dialysis patients.

Autor: Lavery LA; Department of Plastic Surgery, University of Texas Southwestern Medical Center, Parkland Hospital, Dallas, TX, USA., Lavery DC; Statistical Consulting, Aurora, CO, USA., Hunt NA; Orthopaedic and Spine Center of the Rockies, Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA., La Fontaine J; Department of Plastic Surgery, University of Texas Southwestern Medical Center, Parkland Hospital, Dallas, TX, USA., Ndip A; Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester NIHR Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.; Cardiovascular Research group, School of Laboratory and Clinical Sciences, University of Manchester, Manchester, UK., Boulton AJ; Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester NIHR Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Jazyk: angličtina
Zdroj: International wound journal [Int Wound J] 2015 Oct; Vol. 12 (5), pp. 523-6. Date of Electronic Publication: 2013 Sep 19.
DOI: 10.1111/iwj.12146
Abstrakt: Patients with diabetes have increased risk for foot ulcers, amputations and hospitalisations. We evaluated a closed cohort of patients with diabetes and established risk factors in two high risk groups: (i) dialysis patients and (ii) patients with previous foot ulceration. We used claims data for diabetes (ICD-9 250.X), ulceration (ICD-9 707·10, 707·14 and 707·15) and dialysis (CPT 90935-90937) from the Scott and White Health Plan to identify 150 consecutive patients with diabetes on dialysis (dialysis group) and 150 patients with a history of foot ulceration (ulcer history group). We verified these diagnoses by manually reviewing corresponding electronic medical records. Each patient was provided 30 months follow-up period. The incidence of foot ulcers was the same in dialysis patients and patients with an ulcer history (210 per 1000 person-years). The amputation incidence rate was higher in dialysis patients (58·0 versus 13·3, P < 0·001). Hospital admission was common in both study groups. The incidence of hospitalisation was higher in the ulcer history group (477·3 versus 381·3, P < 0·001); however, there were more foot-related hospital admissions in the dialysis group (32·9% versus 14·0%, P < 0·001) during the 30-month evaluation period. The incidence of ulcers, amputations and all-cause hospitalisations is high in persons with diabetes and a history of foot ulceration or on dialysis treatment; however, those on dialysis treatment have disproportionately higher rates of foot-related hospitalisations. Intervention strategies to reduce the burden of diabetic foot disease must target dialysis patients as a high-risk group.
(© 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)
Databáze: MEDLINE
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