Freeman A, May K, Frescos N, Wraight P R
Diabetic Foot Unit, Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Intern Med J. 2008 May;38(5):314-20. doi: 10.1111/j.1445-5994.2007.01528.x. Epub 2007 Nov 13.
Although chronic kidney disease (CKD) has been associated with foot ulceration, the pathological pathway involved remains unclear. This pilot study was designed to investigate the risk factors for foot ulceration in individuals with CKD who do not have diabetes. The aims of this study were to establish the risk status for foot ulceration in individuals with CKD and to identify the particular foot ulcer risk factors most prevalent in this group.
One hundred outpatients were recruited from a metropolitan hospital and allocated into one of four groups: (i) control: neither diabetes nor CKD, (ii) diabetes alone, (iii) coexisting CKD and diabetes and (iv) CKD alone. All participants were assessed for past/current foot ulcers, peripheral neuropathy, vascular insufficiency, structural deformity and skin pathology. Comparisons were made between the groups regarding the prevalence of these factors.
Participants with CKD who did not have diabetes displayed no significant differences in risk factor presentation from those with diabetes alone. Of the participants with CKD and no diabetes, 36% had peripheral neuropathy, 20% had vascular insufficiency and 24% had the copresentation of peripheral neuropathy and structural deformity. Overall, participants with both CKD and diabetes had the highest presentation of past/current foot ulcers, peripheral neuropathy and vascular insufficiency, all significantly more frequent in this group than in controls (P < 0.05). Eight of the total 10 participants found to have a past/current foot ulcer were in end-stage kidney failure.
Individuals with CKD frequently display risk factors for foot ulceration. Risk factors are more prevalent in individuals who also have diabetes and foot ulcers become more frequent with progression to end-stage kidney failure. Risk assessment and patient awareness strategies should therefore be extended to include all patients with CKD so as to reduce future foot ulcer development.
尽管慢性肾脏病（CKD）与足部溃疡有关，但其涉及的病理途径仍不清楚。本前瞻性研究旨在调查无糖尿病的CKD患者发生足部溃疡的危险因素。本研究的目的是确定CKD患者足部溃疡的风险状况，并确定该组中最普遍的特定足部溃疡危险因素。
从一家大都市医院招募了100名门诊患者，并将其分为四组之一：（i）对照组：既无糖尿病也无CKD，（ii）仅患有糖尿病，（iii）同时患有CKD和糖尿病，（iv）仅患有CKD。对所有参与者进行既往/当前足部溃疡、周围神经病变、血管功能不全、结构畸形和皮肤病理评估。比较了这些因素在各组中的患病率。
无糖尿病的CKD参与者在危险因素表现方面与仅患有糖尿病的参与者无显著差异。在无糖尿病的CKD参与者中，36%有周围神经病变，20%有血管功能不全，24%同时有周围神经病变和结构畸形。总体而言，同时患有CKD和糖尿病的参与者既往/当前足部溃疡、周围神经病变和血管功能不全的发生率最高，该组所有这些情况的发生率均显著高于对照组（P<0.05）。在总共10名被发现有既往/当前足部溃疡的参与者中，有8人处于终末期肾衰竭。
CKD患者经常表现出足部溃疡的危险因素。这些危险因素在同时患有糖尿病的个体中更为普遍，并且随着疾病进展至终末期肾衰竭，足部溃疡会变得更加频繁。因此，风险评估和患者意识策略应扩大到所有CKD患者，以减少未来足部溃疡的发生。
