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

Gilhotra, Rajit A., Rodrigues, Beverly T., Vangaveti, Venkat N., Kan, George, Porter, David, Sangla, Kunwarjit S., and Malabu, Usman H. (2016) Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective. Renal Failure, 38. pp. 1-8.

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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.

Item ID: 44327
Item Type: Article (Research - C1)
ISSN: 1525-6049
Keywords: Australia; dialysis; end-stage renal failure; lower limb amputation
Funders: Far North Queensland Hospital Foundation (FNQHF), James Cook University (JCU)
Date Deposited: 01 Aug 2016 23:23
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110306 Endocrinology @ 80%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110312 Nephrology and Urology @ 20%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 100%
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