PHILADELPHIA—Diabetic patients on dialysis who have foot ulcers or who have undergone a foot amputation have a much higher mortality rate at two years than diabetic patients on dialysis without these pathologies, British investigators reported at the 72nd Scientific Sessions of the American Diabetes Association.
Agbor Ndip, MD, specialist registrar and senior clinical fellow at the Manchester Royal Infirmary, and colleagues examined the impact of foot ulcers and amputations on mortality in 192 diabetic patients undergoing dialysis a their institution.
Study participants underwent comprehensive foot examination at enrollment to assess for neuropathy, peripheral arterial disease, foot deformities, and foot ulcers/amputation.
Overall, 102 patients, or 53.1 percent, had died after two years. Thirty-five (59.3%) of 59 patients who had a foot ulcer at baseline had died after two years compared with 55 (41.4%) of 133 patients who did not have a foot ulcer at baseline. Additionally, 26 (74.3%) of 35 patients who had a foot amputation at baseline were dead at two years versus 64 (40.8%) of 157 patients without amputation at baseline. The differences in two-year mortality rates between patients with and without foot pathology were statistically significant.
Foot disease was a strong predictor of mortality on multivariate analysis that controlled for the type and duration of diabetes, age, gender, and patient history of retinopathy, ischemic heart disease, congestive heart failure, cerebrovascular disease, amputation, foot ulcer, peripheral vascular disease, and neuropathy, an active foot ulcer, or poor baseline glycemic control.