Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

Abstract

Background: End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis.

Objective: The study aims to document trends in the prevalence and identify risk factors of non-traumatic LLA in Australian patients on dialysis.

Methods: A retrospective review of all patients (218) who attended the regional dialysis center between 1st January 2009 and 31st December 2013 was conducted. Demographic, clinical and biochemical data were analyzed.

Results: We identified a high prevalence of 13.3% of LLAs amongst Australian patients with ESRF on dialysis at our center. The associated risk factors were the presence of diabetes (OR 1.67 [1.49–1.88] p < 0.001), history of foot ulceration (OR 81 [18.20–360.48] p < 0.001), peripheral arterial disease (OR 31.29 [9.02–108.56] p < 0.001), peripheral neuropathy (OR 31.29 [9.02–108.56] p < 0.001), foot deformity (OR 23.62 [5.82–95.93] p < 0.001), retinopathy (OR 6.08 [2.64–14.02] p < 0.001), dyslipidemia (OR 4.6 [1.05–20.05] p= 0.049) and indigenous background (OR 3.39 [1.38–8.33] p= 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p < 0.05).

Conclusion: There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels.

Keywords:

• Australia
• dialysis
• end-stage renal failure
• lower limb amputation

Disclosure statement

The authors declare that they have no competing interests.

Funding information

Rajit A. Gilhotra was supported financially by the Far North Queensland Hospital Foundation and The School of Medicine and Dentistry, James Cook University.

Authors’ contributions

RG was responsible for design of the study, carrying out the data collection and analysis along with writing of the manuscript, BR participated in the data collection process along with GK and DP’s support. VV has been providing statistics and analytical support along with supervision of the project. KS has provided research assistance throughout the project. UM has been the primary supervisor who conceived of the study along with RG and participated in its design and coordination and helped to draft the manuscript.