Impact of Podiatric Surveillance on Amputation Rates in Patients with Diabetes and Chronic Kidney Disease

Abstract

Development of the triad of peripheral arterial disease, peripheral neuropathy, and end stage renal disease puts people with diabetes at an increased risk of diabetic foot ulcerations and subsequent infections that often precede lower extremity amputations. In patients on hemodialysis, there is a ten-fold increased risk of amputation and an estimated 40%-82% one-year mortality rate if the amputation is a major amputation. This study aimed to examine if patients presenting to a podiatric clinic with stage 3a or 3b chronic kidney disease and a diabetic foot ulcer had decreased rates of amputations as compared to patients who presented after initiating dialysis. Our results demonstrated all major amputations occurred in patients who did not establish with podiatry prior to initiating HD. Additionally, our study revealed a potential access to care disparity for African American patients with chronic kidney disease, as African American patients were established with podiatry prior to initiating dialysis less often in comparison to Caucasian individuals. Our study lays the groundwork for future work investigating the impact of podiatric surveillance on patients with diabetes and end stage renal disease.