Impact of chronic kidney disease on survival after amputation in individuals with diabetes

Lawrence A. Lavery, Nathan A. Hunt, Agbor Ndip, David C. Lavery, William Van Houtum, Andrew J M Boulton

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

OBJECTIVE - To identify factors that influence survival after diabetes-related amputations. RESEARCH DESIGN AND METHODS - We abstracted medical records of 1,043 hospitalized subjects with diabetes and a lower-extremity amputation from 1 January to 31 December 1993 in six metropolitan statistical areas in south Texas. We identified mortality in the 10-year period after amputation from death certificate data. Diabetes was verified using World Health Organization criteria. Amputations were identified by ICD-9-CM codes 84.11- 84.18 and categorized as foot, below-knee amputation, and above-knee amputation and verified by reviewing medical records. We evaluated three levels of renal function: chronic kidney disease (CKD), hemodialysis, and no renal disease. We defined CKD based on a glomerular filtration rate <60 ml/min and hemodialysis from Current Procedural Terminology (CPT) codes (90921, 90925, 90935, and 90937). We used χ2 for trend and Cox regression analysis to evaluate risk factors for survival after amputation. RESULTS - Patients with CKD and dialysis had more below-knee amputations and aboveknee amputations than patients with no renal disease (P < 0.01). Survival was significantly higher in patients with no renal impairment (P < 0.01). The Cox regression indicated a 290% increase in hazard for death for dialysis treatment (hazard ratio [HR] 3.9, 95% CI 3.07-5.0) and a 46% increase for CKD (HR 1.46, 95% CI 1.21-1.77). Subjects with an above-knee amputation had a 167% increase in hazard (HR 2.67, 95% CI 2.14 -3.34), and below-knee amputation patients had a 67% increase in hazard for death. CONCLUSIONS- Survival after amputation is lower in diabetic patients with CKD, dialysis, and high-level amputations.

Original languageEnglish (US)
Pages (from-to)2365-2369
Number of pages5
JournalDiabetes Care
Volume33
Issue number11
DOIs
StatePublished - Nov 2010

Fingerprint

Chronic Renal Insufficiency
Amputation
Survival
Knee
Kidney
Dialysis
Medical Records
Renal Dialysis
Current Procedural Terminology
Death Certificates
International Classification of Diseases
Glomerular Filtration Rate
Foot
Lower Extremity
Research Design
Regression Analysis

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Lavery, L. A., Hunt, N. A., Ndip, A., Lavery, D. C., Van Houtum, W., & Boulton, A. J. M. (2010). Impact of chronic kidney disease on survival after amputation in individuals with diabetes. Diabetes Care, 33(11), 2365-2369. https://doi.org/10.2337/dc10-1213

Impact of chronic kidney disease on survival after amputation in individuals with diabetes. / Lavery, Lawrence A.; Hunt, Nathan A.; Ndip, Agbor; Lavery, David C.; Van Houtum, William; Boulton, Andrew J M.

In: Diabetes Care, Vol. 33, No. 11, 11.2010, p. 2365-2369.

Research output: Contribution to journalArticle

Lavery, LA, Hunt, NA, Ndip, A, Lavery, DC, Van Houtum, W & Boulton, AJM 2010, 'Impact of chronic kidney disease on survival after amputation in individuals with diabetes', Diabetes Care, vol. 33, no. 11, pp. 2365-2369. https://doi.org/10.2337/dc10-1213
Lavery, Lawrence A. ; Hunt, Nathan A. ; Ndip, Agbor ; Lavery, David C. ; Van Houtum, William ; Boulton, Andrew J M. / Impact of chronic kidney disease on survival after amputation in individuals with diabetes. In: Diabetes Care. 2010 ; Vol. 33, No. 11. pp. 2365-2369.
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abstract = "OBJECTIVE - To identify factors that influence survival after diabetes-related amputations. RESEARCH DESIGN AND METHODS - We abstracted medical records of 1,043 hospitalized subjects with diabetes and a lower-extremity amputation from 1 January to 31 December 1993 in six metropolitan statistical areas in south Texas. We identified mortality in the 10-year period after amputation from death certificate data. Diabetes was verified using World Health Organization criteria. Amputations were identified by ICD-9-CM codes 84.11- 84.18 and categorized as foot, below-knee amputation, and above-knee amputation and verified by reviewing medical records. We evaluated three levels of renal function: chronic kidney disease (CKD), hemodialysis, and no renal disease. We defined CKD based on a glomerular filtration rate <60 ml/min and hemodialysis from Current Procedural Terminology (CPT) codes (90921, 90925, 90935, and 90937). We used χ2 for trend and Cox regression analysis to evaluate risk factors for survival after amputation. RESULTS - Patients with CKD and dialysis had more below-knee amputations and aboveknee amputations than patients with no renal disease (P < 0.01). Survival was significantly higher in patients with no renal impairment (P < 0.01). The Cox regression indicated a 290{\%} increase in hazard for death for dialysis treatment (hazard ratio [HR] 3.9, 95{\%} CI 3.07-5.0) and a 46{\%} increase for CKD (HR 1.46, 95{\%} CI 1.21-1.77). Subjects with an above-knee amputation had a 167{\%} increase in hazard (HR 2.67, 95{\%} CI 2.14 -3.34), and below-knee amputation patients had a 67{\%} increase in hazard for death. CONCLUSIONS- Survival after amputation is lower in diabetic patients with CKD, dialysis, and high-level amputations.",
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AB - OBJECTIVE - To identify factors that influence survival after diabetes-related amputations. RESEARCH DESIGN AND METHODS - We abstracted medical records of 1,043 hospitalized subjects with diabetes and a lower-extremity amputation from 1 January to 31 December 1993 in six metropolitan statistical areas in south Texas. We identified mortality in the 10-year period after amputation from death certificate data. Diabetes was verified using World Health Organization criteria. Amputations were identified by ICD-9-CM codes 84.11- 84.18 and categorized as foot, below-knee amputation, and above-knee amputation and verified by reviewing medical records. We evaluated three levels of renal function: chronic kidney disease (CKD), hemodialysis, and no renal disease. We defined CKD based on a glomerular filtration rate <60 ml/min and hemodialysis from Current Procedural Terminology (CPT) codes (90921, 90925, 90935, and 90937). We used χ2 for trend and Cox regression analysis to evaluate risk factors for survival after amputation. RESULTS - Patients with CKD and dialysis had more below-knee amputations and aboveknee amputations than patients with no renal disease (P < 0.01). Survival was significantly higher in patients with no renal impairment (P < 0.01). The Cox regression indicated a 290% increase in hazard for death for dialysis treatment (hazard ratio [HR] 3.9, 95% CI 3.07-5.0) and a 46% increase for CKD (HR 1.46, 95% CI 1.21-1.77). Subjects with an above-knee amputation had a 167% increase in hazard (HR 2.67, 95% CI 2.14 -3.34), and below-knee amputation patients had a 67% increase in hazard for death. CONCLUSIONS- Survival after amputation is lower in diabetic patients with CKD, dialysis, and high-level amputations.

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