Kaminski Michelle R, Raspovic Anita, McMahon Lawrence P, Strippoli Giovanni F M, Palmer Suetonia C, Ruospo Marinella, Dallimore Sarah, Landorf Karl B
Discipline of Podiatry, and Lower Extremity and Gait Studies Program, La Trobe University, Melbourne, Victoria 3086, Australia Department of Podiatry, Eastern Health, Melbourne, Victoria 3156, Australia.
Discipline of Podiatry, and Lower Extremity and Gait Studies Program, La Trobe University, Melbourne, Victoria 3086, Australia.
Nephrol Dial Transplant. 2015 Oct;30(10):1747-66. doi: 10.1093/ndt/gfv114. Epub 2015 May 5.
Adults with end-stage renal disease are at increased risk of foot ulceration and lower extremity amputation. However, the central determinants of lower limb injury and loss are incompletely understood.
We conducted a systematic review of non-randomized studies that quantified the major risk factors for foot ulceration and amputation in adults treated with dialysis and analysed patient populations in which risks were greatest. Random-effects meta-analysis was used to generate summary estimates.
Thirty studies (48 566 participants) were identified. Risk factors for foot ulceration and amputation included previous foot ulceration (odds ratios, OR, 17.56 and 70.13), peripheral arterial disease (OR, 7.52 and 9.12), diabetes (OR, 3.76 and 7.48), peripheral neuropathy (OR, 3.24 and 3.36) and coronary artery disease (OR, 3.92 and 2.49). Participants with foot ulceration or amputation had experienced a longer duration of diabetes (mean difference, MD, 4.04 and 6.07 years) and had lower serum albumin levels (MD, -0.23 and -0.13 g/dL). Risk factors for foot ulceration also included retinopathy (OR, 3.03), previous amputation (OR, 15.50) and higher serum phosphorus levels (MD, 0.40 mg/dL), while risk factors for amputation also included male sex (OR, 1.50), current smoking (OR, 2.26) and higher glycated haemoglobin levels (MD, 0.75%).
Dialysis patients who have markedly higher risks of ulceration or amputation include those with previous foot ulceration or amputation, peripheral neuropathy, diabetes or macrovascular disease. The temporal relationship between these risk factors and the development of foot ulceration and/or limb loss is uncertain and requires further study. Stable estimates of the key risk factors for ulceration and amputation can inform the design of future trials investigating clinical interventions to reduce the burden of lower limb disease in the dialysis population.
终末期肾病成人患者发生足部溃疡和下肢截肢的风险增加。然而，下肢损伤和截肢的主要决定因素尚未完全明确。
我们对非随机研究进行了系统评价，这些研究对接受透析治疗的成人足部溃疡和截肢的主要危险因素进行了量化，并分析了风险最高的患者群体。采用随机效应荟萃分析来生成汇总估计值。
共纳入30项研究（48566名参与者）。足部溃疡和截肢的危险因素包括既往足部溃疡（比值比，OR，分别为17.56和70.13）、外周动脉疾病（OR，分别为7.52和9.12）、糖尿病（OR，分别为3.76和7.48）、外周神经病变（OR，分别为3.24和3.36）以及冠状动脉疾病（OR，分别为3.92和2.49）。发生足部溃疡或截肢的参与者糖尿病病程更长（平均差值，MD，分别为4.04和6.07年），血清白蛋白水平更低（MD，分别为 -0.23和 -0.13 g/dL）。足部溃疡的危险因素还包括视网膜病变（OR，3.03）、既往截肢（OR，15.50）和更高的血清磷水平（MD，0.40 mg/dL），而截肢的危险因素还包括男性（OR，1.50）、当前吸烟（OR，2.26）和更高的糖化血红蛋白水平（MD，0.75%）。
溃疡或截肢风险显著更高的透析患者包括那些有既往足部溃疡或截肢、外周神经病变、糖尿病或大血管疾病的患者。这些危险因素与足部溃疡和/或肢体缺失发生之间的时间关系尚不确定，需要进一步研究。对溃疡和截肢关键危险因素的稳定估计可为未来研究临床干预措施以减轻透析人群下肢疾病负担的试验设计提供参考。
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