Beaumont M, Hobson K, Rax H, Sutton A, Hill A, Lindström D, Dean A
Department of Vascular Surgery, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand.
Auckland University of Technology, Auckland, New Zealand.
ANZ J Surg. 2025 May 31. doi: 10.1111/ans.70194.
This study examines mortality and major limb amputation (MLA) in patients with diabetes-related foot ulcers (DRFU) and renal impairment.
All patients admitted for management of a DRFU between October 2016 and September 2021 at a tertiary hospital in Aotearoa New Zealand (AoNZ) were included and followed until September 2024. Patients were grouped according to renal function: intact renal function; renal impairment with baseline creatinine greater than 150 μmol/L; and requirement for dialysis. Rate of mortality and rate of major limb amputation (MLA) were calculated at 1, 3, 5, and 7 years. Kaplan-Meier probability estimates were utilised to compare the survival and amputation-free survival of the dialysis cohort to the non-dialysis cohort. R Version 4.4.1 and Python were used for statistical analyses.
Seven hundred seventy-two patients were admitted for management of a DRFU, of whom 431 (59%) had intact renal function, 160 (27%) had impaired renal function, and 136 (18.7%) required dialysis. The median follow-up was 19.3 months. Patients in the dialysis cohort were younger, median age 64 years, compared to 70 years in the non-dialysis cohort. Mortality rates were significantly higher in the dialysis cohort at 1 (33.8% vs. 17.6%), 3 (58.8% vs. 37.9%), 5 (69.9% vs. 50.5%) and 7 years (87.6% vs. 64.4%) (p < 0.001) with median survival time of 27.1 months compared to 47.7 months (p < 0.001). The MLA rate was significantly higher in the dialysis cohort at each time point: 1 year (31.6% vs. 3.2%), 3 years (36% vs. 7.5%), 5 years (40.5% vs. 12.4%), and 7 years (42.6% vs. 19.6%) (p < 0.001). There was no difference in outcomes between those with renal impairment and intact renal function cohorts, and no difference by ethnicity.
AoNZ patients with a DRFU and ESRD on dialysis have significantly higher mortality and major amputation rates, even within the first year of a new admission with a DFRU. Limited life expectancy should be considered when planning interventions for these patients.
本研究调查了患有糖尿病相关足部溃疡（DRFU）和肾功能损害患者的死亡率和大肢体截肢（MLA）情况。
纳入2016年10月至2021年9月期间在新西兰奥特亚罗瓦（AoNZ）一家三级医院因DRFU入院治疗的所有患者，并随访至2024年9月。根据肾功能将患者分组：肾功能正常；基线肌酐大于150μmol/L的肾功能损害；以及需要透析。计算1年、3年、5年和7年时的死亡率和大肢体截肢（MLA）率。采用Kaplan-Meier概率估计法比较透析队列与非透析队列的生存率和无截肢生存率。使用R版本4.4.1和Python进行统计分析。
772例患者因DRFU入院治疗，其中431例（59%）肾功能正常，160例（27%）肾功能损害，136例（18.7%）需要透析。中位随访时间为19.3个月。透析队列中的患者更年轻，中位年龄64岁，而非透析队列中位年龄为70岁。透析队列在1年（33.8%对17.6%）、3年（58.8%对37.9%）、5年（69.9%对50.5%）和7年（87.6%对64.4%）时的死亡率显著更高（p<0.001），中位生存时间为27.1个月，而非透析队列为47.7个月（p<0.001）。透析队列在每个时间点的MLA率均显著更高：1年（31.6%对3.2%）、3年（36%对7.5%）、5年（40.5%对12.4%）和7年（42.6%对19.6%）（p<0.001）。肾功能损害队列与肾功能正常队列的结局无差异，按种族划分也无差异。
在新西兰奥特亚罗瓦，患有DRFU且接受透析的终末期肾病患者的死亡率和大截肢率显著更高，即使在因DFRU新入院的第一年内也是如此。在为这些患者制定干预措施时应考虑到预期寿命有限。
