Seo Min Jun, Lee Dong Geon, Ko Se Yun, Song Ga Yeong, Lee Geon Yeong, Kim Sung Hwa, Kang Dae Ryong, Kim Jiye, Lee Jun Young
Department of Plastic Surgery, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea.
J Clin Med. 2023 Aug 30;12(17):5641. doi: 10.3390/jcm12175641.
Individuals with end-stage kidney disease (ESKD) on dialysis are at a high risk of developing foot ulcerations and undergoing subsequent lower extremity amputation (LEA), which can exert significant impacts on their quality of life and contribute to rising healthcare costs. We aimed to identify risk factors associated with LEA in patients with ESKD to predict LEA progression and eventually prevent it. We used 18 years (2002-2019) of data from the Korean National Health Insurance Service (KNHIS). Data were collected from patients with ESKD who underwent renal replacement therapy (RRT) and had no history of amputation caused by trauma or toxins. The risk factors were compared between patients with or without LEA. We collected data from 220,838 patients newly diagnosed with ESKD, including 6348 in the LEA group and 214,490 in the non-LEA group. The total incidence of LEA was 2.9%. Older age, male gender, lower income, non-metropolitan residence, diabetes mellitus, dialysis treatment (compared to kidney transplantation), microvascular disease, peripheral vascular disease, endovascular procedure, and endovascular operation were associated with an increased risk of LEA. Thus, individuals with ESKD who are at a higher risk for LEA should be closely monitored, and kidney transplantation should be considered as a preventative measure.
接受透析治疗的终末期肾病（ESKD）患者发生足部溃疡及随后进行下肢截肢（LEA）的风险很高，这会对他们的生活质量产生重大影响，并导致医疗费用不断上升。我们旨在确定ESKD患者中与LEA相关的风险因素，以预测LEA的进展并最终预防它。我们使用了韩国国民健康保险服务（KNHIS）18年（2002 - 2019年）的数据。数据收集自接受肾脏替代治疗（RRT）且无创伤或毒素导致的截肢病史的ESKD患者。比较了有或没有LEA的患者之间的风险因素。我们收集了220,838例新诊断为ESKD患者的数据，其中LEA组有6348例，非LEA组有214,490例。LEA的总发生率为2.9%。年龄较大、男性、收入较低、居住在非大都市地区、患有糖尿病、接受透析治疗（与肾移植相比）、微血管疾病、外周血管疾病、血管内介入治疗和血管内手术与LEA风险增加相关。因此，LEA风险较高的ESKD患者应密切监测，肾移植应作为一种预防措施加以考虑。
