Growing Evidence of the Impact of Podiatric Care: End-Stage Renal Disease and DFU

Our team recently presented an abstract the American Diabetes Association Annual Symposium.¹ We’re thrilled that Tze Woei Tan, lead author, was awarded the Marvin Levin Award for top abstract in its category. The study, the first of its kind, evaluated more than 50,000 patients with end-stage renal disease (ESRD). Those that received podiatric care prior to developing a diabetic foot ulcer (DFU) were approximately 18% less likely to die or have an amputation over four years of study follow-up.
 
We aimed to evaluate the impact of foot care by podiatric surgeons on outcomes of new DFU in patients with ESRD using claims data from the US Renal Data System. Patients over 40 years old and on dialysis for more than one year were stratified into either an intervention or control cohort based on receipt of foot care by a podiatric surgeon within 12 months of a new DFU.
 
Just under one-third (31.5 percent) received podiatric care in that year prior to the index DFU. This group was older, more likely to be female and had a higher rate of PAD compared to the control group. The average rate of major amputation among both groups was 9.6 percent. A Kaplan-Meier estimate revealed that pre-DFU foot care correlated with increased amputation-free survival.
 
Patients with ESRD are so important to study because they constitute a unique and advanced pathology. They definitely require more attention and are at much higher risk for non-healing, amputation, and early death. In fact, a patient with ESRD on renal replacement has a five-year mortality equivalent to lung cancer.²

Although vascular and neurological function are typical metrics as part of a diabetic foot evaluation, DPMs should ask questions more regularly about renal status as well. Surgeons are now paying a lot of attention to this patient population. This is certainly true for those that specialize in limb preservation. In fact, in our flagship limb preservation program at the University of Southern California, fully 40% of the patients we see now are on renal replacement.

This be an opportunity for DPMs to network and collaborate with renal colleagues to benefit this especially at-risk population. In fact, we have just recruited a vascular surgeon, whose wife (who we already adore) was simultaneously recruited chief of nephrology at one of our hospitals! Working together in concert with other specialties continue to prove to be an effective approach for our patients.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA). 

Editor’s note: This blog originally appeared here. It is adapted with permission from the author.

Disclaimer: The views and opinions expressed are those of the author(s) and do not necessarily reflect the official policy or position of Podiatry Today or HMP Global, their employees and affiliates. Any content provided by our bloggers or authors are of their opinion and are not intended to malign any religion, ethnic group, club, association, organization, company, individual, anyone or anything.

References
1.     Tan T-W, Armstrong DG, Chong CC, et al. Association between preventive podiatric care and outcomes of new diabetic foot ulceration among patients with end-stage renal disease. Diabetes 2022;71(Supplement_1):125-OR. https://doi.org/10.2337/db22-125-OR .
2.     Naylor KL, Kim SJ, McArthur E, Garg AX, McCallum MK, Knoll GA. Mortality in incident maintenance dialysis patients versus incident solid organ cancer patients: a population-based cohort. Am J Kidney Dis. 2019 Jun;73(6):765-776. doi: 10.1053/j.ajkd.2018.12.011.