Does the Start of Dialysis Initiate a Period of Increased Risk of Ulceration or Amputation?

Lawrence A. Lavery, David C. Lavery, Nathan A. Hunt, Javier La Fontaine, Ryan D. Lavery

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Dialysis therapy is associated with an increased incidence of lower-extremity wounds and amputations. We compared the incidence of foot ulcers and amputations before and after the start of dialysis.

METHODS: We evaluated 150 consecutive diabetic patients receiving dialysis and compared the incidence of foot complications 30 months before and after initiation of hemodialysis. We used claims data for diabetes, ulceration, and dialysis and abstracted medical records to verify diagnoses and dates of ulcers and amputations. We compared initial and cumulative ulcer/amputation incidence to account for multiple events in the same person over time. We used the same formula to determine the incidence rate difference and 95% confidence intervals (CIs) to compare new ulcers and amputations during the study.

RESULTS: There was no significant difference in the incidence of first foot ulcers before (91.7 per 1,000 patient-years; 95% CI, 73.7-112.3 per 1,000 patient-years) and after (82.7; 95% CI, 65.7-102.3) the start of hemodialysis. The incidence of cumulative ulcers was significantly higher before (304.0 per 1,000 patient-years; 95% CI, 270.8-340.2) compared with after (210.7 per 1,000 patient-years; 95% CI, 183.0-240.9) dialysis. There was no difference in the incidence of first amputation before (29.3 per 1,000 patient-years; 95% CI, 1 9.4-41.7 per 1,000 patient-years) and after (37.3 per 1,000 patient-years; 95% CI, 19.4-41.7 per 1,000 patient-years) dialysis or in the cumulative incidence of amputations before (61.3 per 1,000 patient-years; 95% CI, 46.7-8.4 per 1,000 patient-years) and after (58.7 per 1,000 patient-years; 95% CI, 44.5-75.5 per 1,000 patient-years) dialysis.

CONCLUSIONS: There was no increase in the incidence of ulcers or amputations after beginning hemodialysis.

Original languageEnglish (US)
Pages (from-to)1-5
Number of pages5
JournalJournal of the American Podiatric Medical Association
Volume108
Issue number1
DOIs
StatePublished - Jan 1 2018

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Amputation
Dialysis
Confidence Intervals
Incidence
Ulcer
Foot Ulcer
Renal Dialysis
Medical Records
Foot
Lower Extremity

ASJC Scopus subject areas

  • Podiatry
  • Orthopedics and Sports Medicine

Cite this

Does the Start of Dialysis Initiate a Period of Increased Risk of Ulceration or Amputation? / Lavery, Lawrence A.; Lavery, David C.; Hunt, Nathan A.; Fontaine, Javier La; Lavery, Ryan D.

In: Journal of the American Podiatric Medical Association, Vol. 108, No. 1, 01.01.2018, p. 1-5.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Dialysis therapy is associated with an increased incidence of lower-extremity wounds and amputations. We compared the incidence of foot ulcers and amputations before and after the start of dialysis.METHODS: We evaluated 150 consecutive diabetic patients receiving dialysis and compared the incidence of foot complications 30 months before and after initiation of hemodialysis. We used claims data for diabetes, ulceration, and dialysis and abstracted medical records to verify diagnoses and dates of ulcers and amputations. We compared initial and cumulative ulcer/amputation incidence to account for multiple events in the same person over time. We used the same formula to determine the incidence rate difference and 95{\%} confidence intervals (CIs) to compare new ulcers and amputations during the study.RESULTS: There was no significant difference in the incidence of first foot ulcers before (91.7 per 1,000 patient-years; 95{\%} CI, 73.7-112.3 per 1,000 patient-years) and after (82.7; 95{\%} CI, 65.7-102.3) the start of hemodialysis. The incidence of cumulative ulcers was significantly higher before (304.0 per 1,000 patient-years; 95{\%} CI, 270.8-340.2) compared with after (210.7 per 1,000 patient-years; 95{\%} CI, 183.0-240.9) dialysis. There was no difference in the incidence of first amputation before (29.3 per 1,000 patient-years; 95{\%} CI, 1 9.4-41.7 per 1,000 patient-years) and after (37.3 per 1,000 patient-years; 95{\%} CI, 19.4-41.7 per 1,000 patient-years) dialysis or in the cumulative incidence of amputations before (61.3 per 1,000 patient-years; 95{\%} CI, 46.7-8.4 per 1,000 patient-years) and after (58.7 per 1,000 patient-years; 95{\%} CI, 44.5-75.5 per 1,000 patient-years) dialysis.CONCLUSIONS: There was no increase in the incidence of ulcers or amputations after beginning hemodialysis.",
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