University of Texas Southwestern Medical School, Dallas, TX, USA.
Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
J Diabetes Complications. 2024 Nov;38(11):108876. doi: 10.1016/j.jdiacomp.2024.108876. Epub 2024 Sep 28.
Lower extremity amputation (LEA) is one of the most feared consequences of diabetes mellitus (DM). The purpose of this study was to evaluate the impact of DM on LEA rates in patients at various stages of chronic kidney disease (CKD). A commercially available de-identified database was searched for patients undergoing LEA and for CKD patients, from 2010 to 2023. Patients with DM and patients without DM who were followed for at least 5 years were included. LEA rates were then compared for patients at all 5 CKD stages in patients with and without diabetes. Rates of all LEA were found to be significantly higher at all CKD stages for patients with diabetes (overall, minor and major LEA). Compared to patients without DM who have CKD stage 5 (end stage renal disease), patients with DM and CKD stage 5 have a 30 fold increased likelihood of undergoing overall LEA [OR 30.2 (24.48-37.19), p < 0.001], 29 fold increased likelihood of undergoing minor LEA [28.9i (22.91-36.35), p < 0.001] and 40 times fold increased likelihood of undergoing major LEA [40.1 (26.59-60.42), p < 0.001]. For all stages of CKD, independent of diabetes status, minor LEA were performed with greater frequency than major LEA. In patients with DM, LEA rates significantly increased with CKD progression between stages 2-5 with a substantial jump between stages 4 and 5 [OR 2.6 (CI 2.49-2.74), p < 0.001]. However, CKD progression between stages 1 and 2 was not significantly associated with increased LEA rates (OR 1.1 (CI 0.92-1.21), p = 0.24) in patients with diabetes. Patients with comorbid diabetes have elevated risk for LEA at all stages of CKD compared to those without diabetes.
下肢截肢（LEA）是糖尿病（DM）最可怕的后果之一。本研究旨在评估 DM 对慢性肾脏病（CKD）各阶段患者 LEA 发生率的影响。从 2010 年到 2023 年，使用商业上可用的去识别数据库搜索接受 LEA 和 CKD 患者的患者。纳入至少随访 5 年的有 DM 和无 DM 的患者。然后比较了糖尿病和无糖尿病患者在所有 5 个 CKD 阶段的 LEA 发生率。在所有 CKD 阶段，患有糖尿病的患者的所有 LEA 发生率均显著更高（总体、小截肢和大截肢）。与无 DM 的 CKD 第 5 期（终末期肾病）患者相比，患有 DM 且 CKD 第 5 期的患者总体 LEA 的可能性增加 30 倍[OR 30.2（24.48-37.19），p<0.001]，小截肢的可能性增加 29 倍[28.9i（22.91-36.35），p<0.001]，大截肢的可能性增加 40 倍[40.1（26.59-60.42），p<0.001]。对于所有 CKD 阶段，无论糖尿病状态如何，小截肢的频率均高于大截肢。在患有 DM 的患者中，随着 CKD 在 2-5 期之间的进展，LEA 发生率显著增加，而在 4-5 期之间则有明显增加[OR 2.6（CI 2.49-2.74），p<0.001]。然而，在患有糖尿病的患者中，CKD 从 1 期到 2 期的进展与 LEA 发生率的增加没有显著相关性[OR 1.1（CI 0.92-1.21），p=0.24]。与无糖尿病患者相比，患有合并糖尿病的患者在所有 CKD 阶段的 LEA 风险均升高。
