Bonnet Jean-Baptiste, Szwarc Ilan, Avignon Antoine, Jugant Sébastien, Sultan Ariane
Diabetes-Nutrition Department, University Hospital of Montpellier, Montpellier, France.
UMR 1302, Institute Desbrest of Epidemiology and Public Health, University Montpellier, INSERM, CHU, Montpellier, France.
Clin Kidney J. 2023 May 11;16(11):2156-2163. doi: 10.1093/ckj/sfad106. eCollection 2023 Nov.
Chronic kidney disease (CKD) is correlated with the incidence of diabetic foot ulcer (DFU). Furthermore, the International Working Group on the Diabetic Foot (IWGDF) has proposed a classification of the risk factors for DFU. The purpose of this study was to investigate the relationship between the IWGDF risk classification and the glomerular filtration rate level estimated by the CKD Epidemiology Collaboration formula (eGFR).
We conducted a prospective multicentric study. Patients were recruited from either diabetology or nephrology departments. The secondary objectives were to determine this relationship after excluding people on dialysis and to identify the factors associated with podiatric risk.
Four hundred and eighty-six patients were included, with a mean age of 64.2 years (±15.7) and a mean diabetes duration of 15.7 years (±12.1). Based on the IWGDF classification, 53.5% of the population were in podiatric stage 0, 11.7% in stage 1 and 34.8% in stage 2 or 3. The mean eGFR level was significantly lower in patients with podiatric risk ≥2 (36.8 ± 33.9 mL/min/1.73 m vs 71.9 ± 35.3 mL/min/1.73 m, < .0001) and a significant association was found between the eGFR and the podiatric risk. This association remained significant after the exclusion of the hemodialysis patients. After receiver operating characteristic analysis, a cutoff of 45 ± 11 mL/min/1.73 m (area under the curve 0.76) was found discriminant to define a group of CKD patients at higher risk for podiatric stage ≥2.
eGFR levels are linked to podiatric stages in diabetes mellitus. Patients with eGFR <45 mL/min/1.73 m and dialysis patients should be carefully managed in collaboration with diabetic foot specialized centers.
慢性肾脏病（CKD）与糖尿病足溃疡（DFU）的发生率相关。此外，国际糖尿病足工作组（IWGDF）提出了DFU危险因素的分类。本研究的目的是探讨IWGDF风险分类与采用CKD流行病学协作公式估算的肾小球滤过率水平（eGFR）之间的关系。
我们进行了一项前瞻性多中心研究。患者从糖尿病科或肾内科招募。次要目标是在排除透析患者后确定这种关系，并确定与足部风险相关的因素。
纳入486例患者，平均年龄64.2岁（±15.7），平均糖尿病病程15.7年（±12.1）。根据IWGDF分类，53.5%的人群处于足部0期，11.7%处于1期，34.8%处于2期或3期。足部风险≥2的患者的平均eGFR水平显著较低（36.8±33.9ml/min/1.73m² vs 71.9±35.3ml/min/1.73m²，P<0.0001）,并且发现eGFR与足部风险之间存在显著关联。排除血液透析患者后，这种关联仍然显著。经过受试者工作特征分析，发现截断值为45±11ml/min/1.73m²（曲线下面积为0.76）可用于区分一组足部≥2期风险较高的CKD患者。
eGFR水平与糖尿病患者的足部分期相关。eGFR<45ml/min/1.73m²的患者和透析患者应与糖尿病足专科中心合作进行仔细管理。
