Many amputations among dialysis patients with diabetes 'unnecessary'

Improvements in foot treatment among people with diabetes undergoing kidney dialysis could lead to fewer amputations, says UK research

Posted by: WebMD Health News

16th September 2011 - Diabetes patients who are also undergoing kidney dialysis need more intensive foot care to reduce their risk of lower-limb amputations, says a new study.

Diabetes is the most common cause of kidney disease, and people with diabetes are already at increased risk of developing foot ulcers and slow-healing wounds which, if become infected, can lead to amputations. The risk stems from damage to nerves and blood supply to the feet.

Preventable

There are an estimated 100 amputations a week among people with diabetes in the UK, but experts say between 49% and 85% could have been prevented.

Dr Agbor Ndip and Professor Andrew Boulton from the University of Manchester analysed what happened to 326 patients with diabetes and late-stage chronic kidney disease. The patients had an average age of 64 and either attended a diabetes centre in the city or one of several dialysis units.

Nerve damage

They found that, in comparison to patients not undergoing dialysis, people receiving the treatment had a higher prevalence of diabetic nerve damage (79%) compared with those who were not receiving dialysis (65%).

Among other findings were that:

·         15% of patients receiving dialysis had undergone amputations, compared with 6.4% who were not having dialysis

·         32% of patients receiving dialysis had a history of foot ulcers, compared with 20% who did not have dialysis

·         21% of patients on dialysis had foot ulcers at the time of the study compared with 5% who did not have the treatment.

Dr Ndip says physical changes, like tissue oxygenation and fluid shifts in the body, can contribute to ulceration. He tells us that the problem is exacerbated by the four hours patients spend lying on dialysis couches. Those with diabetic neuropathy - in which damage to the nerves blocks the sensation of pain in the feet - can end up with blisters, "and it's these blisters which then burst and form an ulcer and the ulcers then don't heel," he says.

Inadequate foot care

Significantly, the researchers also found that people on dialysis were less likely to have regular foot care, compared with those not on dialysis.

Ndip, who was speaking to us from the Association for the Study of Diabetes conference in Lisbon, Portugal, where he was due to present his paper, says: "When people are on dialysis they fail to attend for other diabetes care; they fail to attend for podiatry care to look after their feet, and they neglect these things because being on dialysis is more important than anything else."

Ndip says this 'treatment fatigue' cannot be blamed on patients alone, and that medical staff need to spend much more time ensuring that patients on dialysis receive appropriate and intensive foot care.

'Challenge'

Dr Victoria King, Head of Research at Diabetes UK, which helped to fund the study, said in a statement: "Diabetes is the leading cause of lower limb amputations in the UK so research like this is crucial in helping us understand the factors which need to be considered when trying to prevent and reduce the prevalence of this devastating complication.”

Diabetes UK is calling on the Government and commissioners to tackle the challenge of prevention now - through raising awareness, education and improving access to specialist services. People need help to reduce their risk of developing life-threatening complications which have such a significant impact on the individual and society as a whole."

Please call the Foot, Ankle & Lower Leg Center office in Las Vegas anytime @702-878-2455 between Monday – Friday and we would be happy to set up an appointment for you.  Please visit our website @ www.FallCenter.com or www.walkwithdiabetes.com.   The Foot, Ankle & Lower Leg Center has Diagnostic imaging:  Digital X-Rays, Ultrasound or Advanced Imaging will be used to aid in the diagnosis.

Dr. Anthony Ricciardi at the Foot, Ankle & Lower Leg Center has completed training in endoscopic/minimally invasive surgery for chronic heel pain and nerve pain, foot and ankle joint replacement for restoring pain free motion, arthroscopic surgery, bunion surgery, fracture repair, flat foot correction, external fixation for complex deformities and extensive experience in peripheral nerve surgery including diabetic peripheral neuropathy and reconstructive surgery of previously failed foot surgical procedures.  In addition to his surgical training Dr. Ricciardi focuses on sports medicine of the foot and ankle through regenerative techniques using the patient’s own blood/platelets for healing chronic foot and ankle problems (pain) as a result of repetitive sport injuries.  This cutting edge technology enables patients to continue training with little or no down time.  Dr. Ricciardi continues to be active in teaching and training other podiatric surgeons on innovative surgical techniques in foot surgery.  Dr. Ricciardi is Board Certified by the American Board of Podiatric Surgery, a Fellow of the American College of Foot and Ankle Surgeons and Fellow of the Association of Extremity Nerve Surgeons.  Dr. Ricciardi’s vision is to bring each patient the most current state of the Art Technology and personalized treatment options to meet their Foot and Ankle needs (from conservative care to surgical options).  Dr. Ricciardi believes in quality service and puts his patients first!