Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective.

Autor: Gilhotra RA; a School of Medicine and Dentistry, James Cook University , Townsville , Australia., Rodrigues BT; a School of Medicine and Dentistry, James Cook University , Townsville , Australia., Vangaveti VN; a School of Medicine and Dentistry, James Cook University , Townsville , Australia., Kan G; a School of Medicine and Dentistry, James Cook University , Townsville , Australia., Porter D; a School of Medicine and Dentistry, James Cook University , Townsville , Australia., Sangla KS; a School of Medicine and Dentistry, James Cook University , Townsville , Australia., Malabu UH; a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
Jazyk: angličtina
Zdroj: Renal failure [Ren Fail] 2016 Aug; Vol. 38 (7), pp. 1036-43. Date of Electronic Publication: 2016 Jun 08.
DOI: 10.1080/0886022X.2016.1193872
Abstrakt: Background: End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis.
Objective: The study aims to document trends in the prevalence and identify risk factors of non-traumatic LLA in Australian patients on dialysis.
Methods: A retrospective review of all patients (218) who attended the regional dialysis center between 1st January 2009 and 31st December 2013 was conducted. Demographic, clinical and biochemical data were analyzed.
Results: We identified a high prevalence of 13.3% of LLAs amongst Australian patients with ESRF on dialysis at our center. The associated risk factors were the presence of diabetes (OR 1.67 [1.49-1.88] p < 0.001), history of foot ulceration (OR 81 [18.20-360.48] p < 0.001), peripheral arterial disease (OR 31.29 [9.02-108.56] p < 0.001), peripheral neuropathy (OR 31.29 [9.02-108.56] p < 0.001), foot deformity (OR 23.62 [5.82-95.93] p < 0.001), retinopathy (OR 6.08 [2.64-14.02] p < 0.001), dyslipidemia (OR 4.6 [1.05-20.05] p= 0.049) and indigenous background (OR 3.39 [1.38-8.33] p= 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p < 0.05).
Conclusion: There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels.
Databáze: MEDLINE
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