Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester National Institute Health Research Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
Diabetes Care. 2010 Aug;33(8):1811-6. doi: 10.2337/dc10-0255. Epub 2010 May 18.
To determine whether dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and renal impairment.
We performed a cross-sectional study of consecutive patients with diabetes and stage 4 or 5 chronic kidney disease (CKD) attending clinics in Manchester (U.K.). Patients were classified as either receiving dialysis therapy (dialysis) or not (no dialysis). Foot assessment included diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), prior foot ulceration and amputation, and foot self-care. Risk factors for prevalent foot ulceration were assessed by logistic regression.
We studied 326 patients with diabetes and CKD (mean age 64 years; 61% male; 78% type 2 diabetes; 11% prevalent foot ulceration). Compared with no dialysis patients, dialysis patients had a higher prevalence of DPN (79 vs. 65%), PAD (64 vs. 43%), prior amputations (15 vs. 6.4%), prior foot ulceration (32 vs. 20%), and prevalent foot ulceration (21 vs. 5%, all P < 0.05). In univariate analyses, foot ulceration was related to wearing bespoke footwear (odds ratio 5.6 [95% CI 2.5-13]) dialysis treatment (5.1 [2.3-11]), prior foot ulceration (4.8 [2.3-9.8], PAD (2.8 [1.3-6.0], and years of diabetes (1.0 [1.0-1.1], all P < 0.01). In multivariate logistic regression, only dialysis treatment (4.2 [1.7-10], P = 0.002) and prior foot ulceration (3.1 [1.3-7.1], P = 0.008) were associated with prevalent foot ulceration.
Dialysis treatment was independently associated with foot ulceration. Guidelines should highlight dialysis as an important risk factor for foot ulceration requiring intensive foot care.
确定透析治疗是否是伴有肾功能损害的糖尿病患者足部溃疡的独立危险因素。
我们对在英国曼彻斯特诊所就诊的连续的伴有糖尿病和 4 或 5 期慢性肾脏病（CKD）的患者进行了一项横断面研究。患者分为接受透析治疗（透析）和未接受透析治疗（非透析）。足部评估包括糖尿病周围神经病变（DPN）、外周动脉疾病（PAD）、既往足部溃疡和截肢以及足部自我护理。采用 logistic 回归评估现患足部溃疡的危险因素。
我们研究了 326 例伴有 CKD 的糖尿病患者（平均年龄 64 岁；61%为男性；78%为 2 型糖尿病；11%现患足部溃疡）。与非透析患者相比，透析患者 DPN（79% vs. 65%）、PAD（64% vs. 43%）、既往截肢（15% vs. 6.4%）、既往足部溃疡（32% vs. 20%）和现患足部溃疡（21% vs. 5%）的患病率更高（所有 P < 0.05）。在单变量分析中，足部溃疡与穿着定制鞋具（比值比 5.6 [95%CI 2.5-13]）、透析治疗（5.1 [2.3-11]）、既往足部溃疡（4.8 [2.3-9.8]）、PAD（2.8 [1.3-6.0]）和糖尿病病程（1.0 [1.0-1.1]）有关，所有 P 值均<0.01。在多变量 logistic 回归分析中，仅透析治疗（4.2 [1.7-10]，P = 0.002）和既往足部溃疡（3.1 [1.3-7.1]，P = 0.008）与现患足部溃疡有关。
透析治疗与足部溃疡独立相关。指南应强调透析是足部溃疡的重要危险因素，需要进行强化足部护理。
