The Effect of Hemodialysis on Diabetic Foot Complications

Introduction: People with diabetes undergoing hemodialysis are ten times more likely to undergo lower extremity amputation than people with diabetes alone. Regular podiatric care is shown to have protective benefits against adverse outcomes in people with diabetes. Despite this, little is known regarding the effect of preventative care with podiatric medicine in the setting of patients on hemodialysis. This study evaluated the effect of preventative podiatric care on risk of amputation in people with chronic kidney disease.Methods:A retrospective review was conducted of consecutive patients from Jan 2016- March 2020 managed by podiatric physicians at a tertiary academic hospital with chronic kidney disease stage 3a or worse. Patients were followed for no less than 2 years and evaluated for adverse outcomes such as new index foot ulcer, re-ulceration, amputation, and date of hemodialysis initiation.Results:82 patients were identified: 49 individuals had chronic kidney disease but had not commenced hemodialysis, while 33 individuals having had been on dialysis. 17 of the chronic kidney disease without dialysis underwent a lower extremity amputation (35%), and nineteen of the chronic kidney disease with dialysis patients underwent an amputation (58%). Of the 33 patients undergoing hemodialysis, 13 had established with podiatry before starting dialysis of which seven underwent an amputation, all of which were minor amputations (transmetatarsal or distal). Of the remaining 20 whom did not establish with podiatry before dialysis, eight underwent amputation, of which five were major lower extremity amputations. There was 2.5x odds ratio of amputation for patients undergoing hemodialysis compared to individuals with CKD not undergoing hemodialysis (p