Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: study protocol for a prospective observational cohort study

Abstract Background: The optimal choice of treatment, with hemodialysis (HD) or peritoneal dialysis (PD), for end-stage renal disease (ESRD) patients, is yet controversial. Only a few studies comparing HD and PD have been conducted in China with the largest number of dialysis patients in the world.Methods: A retrospective cohort study was conducted on ESRD patients who began renal replacement treatment from January 1, 2012 to December 31, 2017 in Guangdong Provincial Hospital of Chinese Medicine. Propensity scoring match was applied to balance the baseline conditions and multivariate Cox regression analysis to compare the mortality between HD and PD patients, and evaluated the correlation between mortality and various baseline characteristics.Results: A total of 436 HD patients and 501 PD patients were included in this study, and PD patients had better survival than HD patients, but the difference was not statistically significant. For younger ESRD patients (≤60-years-old), the overall survival of PD was better than that of HD, but HD was associated with a lower risk of death in older patients (>70-years-old). This difference was still significant after adjustment for a variety of confounding factors. Female gender, age of dialysis initiation, cardiovascular disease, cholesterol, and HD were risk factors of all-cause mortality in the younger subgroup, while PD was risk factors in the older subgroup.Conclusion: Younger ESRD patients may be suitable for PD, and the older ESRD patients for HD.

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The Role of Qutenza® (Topical Capsaicin 8%) in Treating Neuropathic Pain from Critical Ischemia in Patients with End-Stage Renal Disease: An Observational Cohort Study

Pain Medicine ◽

10.1093/pm/pnw139 ◽

2016 ◽

pp. pnw139

Author(s):

Emma Aitken ◽

Gillian McColl ◽

David Kingsmore

Keyword(s):

Neuropathic Pain ◽

Cohort Study ◽

End Stage Renal Disease ◽

Observational Cohort Study ◽

Critical Ischemia ◽

Observational Cohort ◽

Topical Capsaicin ◽

Stage Renal Disease ◽

End Stage

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Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: a prospective observational cohort study

BMC Nephrology ◽

10.1186/s12882-019-1594-5 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Michelle R. Kaminski ◽

Katrina A. Lambert ◽

Anita Raspovic ◽

Lawrence P. McMahon ◽

Bircan Erbas ◽

...

Keyword(s):

Risk Factors ◽

Renal Disease ◽

End Stage Renal Disease ◽

Arterial Disease ◽

Multinomial Regression ◽

Dialysis Patients ◽

Foot Ulceration ◽

History Of ◽

Stage Renal Disease ◽

End Stage

Abstract Background Dialysis patients experience high rates of foot ulceration. Although risk factors for ulceration have been extensively studied in patients with diabetes, there is limited high-quality, longitudinal evidence in the dialysis population. Therefore, this study investigated risk factors for foot ulceration in a stable dialysis cohort. Methods We prospectively collected clinical, demographic, health status, and foot examination information on 450 adults with end-stage renal disease from satellite and home-therapy dialysis units in Melbourne, Australia over 12 months. The primary outcome was foot ulceration. Cox proportional hazard modelling and multinomial regression were used to investigate risk factors. Results Among 450 dialysis patients (mean age, 67.5 years; 64.7% male; 94% hemodialysis; 50.2% diabetes), new cases of foot ulceration were identified in 81 (18%) participants. Overall, risk factors for foot ulceration were neuropathy (HR 3.02; 95% CI 1.48 to 6.15) and previous ulceration (HR 2.86; CI 1.53 to 5.34). In those without history of ulceration, nail pathology (RR 3.85; CI 1.08 to 13.75) and neuropathy (RR 2.66; CI 1.04 to 6.82) were risk factors. In those with history of ulceration, neuropathy (RR 11.23; CI 3.16 to 39.87), peripheral arterial disease (RR 7.15; CI 2.24 to 22.82) and cerebrovascular disease (RR 2.08; CI 1.04 to 4.16) were risk factors. There were 12 (2.7%) new amputations, 96 (21.3%) infections, 24 (5.3%) revascularizations, 42 (9.3%) foot-related hospitalizations, and 52 (11.6%) deaths. Conclusions Neuropathy and previous ulceration are major risk factors for foot ulceration in dialysis patients. Risk factors differ between those with and without prior ulceration. The risk factors identified will help to reduce the incidence of ulceration and its associated complications.

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