Skip to main content
SpringerLink
Log in

Influence of diabetes on persistent nonhealing ischemic foot ulcer in end-stage renal disease

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

The aim of this study was to identify important atherosclerotic risk factors for characteristic nonhealing ischemic foot ulcers in patients with end-stage renal failure. We retrospectively studied 534 consecutive hemodialysis patients in five dialysis units of the Tokyo metropolitan area between 1980 and 1999. The influence of risk factors for ischemic foot ulcers in hemodialysis patients was determined using a multivariate logistic model. The characteristic features were also evaluated with further comparison of the prevalence of risk factors between hemodialyzed diabetic patients with ischemic foot ulcers and another 61 age- and gender-matched nonhemodialyzed diabetic patients with ischemic foot ulcers. In the logistic model, two factors emerged as important risk factors for ischemic foot ulcers: renal failure due to diabetes [odds ratio 21.580 (95% CI 4.838–96.251); p=0.0001] and a history of cerebrovascular disease [odds ratio 2.782 (1.015–7.624); p=0.0467]. On the basis of a comparison of age- and gender-matched control patients, associated diabetic triopathy, a history of cerebrovascular disease, and hypertension were more frequent in the hemodialysis patients. The development of ischemic foot ulcers in those with end-stage renal failure is strongly influenced by underlying advanced diabetic microangiopathy and such other factors as sequelae of cerebrovascular disease and patient debilitation.

Résumé

Le but de cette étude a été de déterminer les facteurs de risque de l’athérosclérose et leur rôle dans la cicatrisation d’ulcères ischémiques chroniques du pied, lésion caractéristique de l’insuffisance rénale terminale. Nous avons étudié de façon rétrospective 534 patients consécutifs en hémodialyse dans cinq unités de dialyse dans la région métropolitaine de Tokyo entre 1980 et 1999. Les facteurs favorisants de l’ulcère ischémique du pied chez le patient en hémodialyse ont été déterminés par un modèle de régression logistique. Les facteurs caractéristiques ont également été évalués par une comparaison ultérieure de la prévalence des facteurs de risque entre les patients diabétiques porteurs d’ulcère ischémique du pied et 61 autres patients diabétiques non hemodialyses, appariés pour l’âge et le sexe. Selon le modèle logistique, deux facteurs ont émergé comme facteurs de risque importants pour l’ulcère ischémique du pied: l’insuffisance rénale en rapport avec le diabète [rapport de côte: 21.580 (95% IC: 4.838–96.251), p=0.0001] et histoire de maladie cérébrovasculaire [rapport de côte=2.782 (1.015–7.624), p=0.0467]. Basé sur la comparaison des patients appariés pour l’âge et le sexe, la triopathie diabétique associée, une histoire de maladie cérébrovasculaire et une hypertension sont plus fréquemment constatées chez lez patients hemodialyses. Le développement d’ulcère ischémique du pied dans l’insuffisance rénale terminale est fortement influencé par la microangiopathic diabétique avancée et d’autres facteurs tels les séquelles de maladie cérébrovasculaire et la debilitation du patient.

Resumen

El trabajo trata de averiguar la importancia de los factores de riesgo arterioescleróticos en la génesis del mal perforante plantar, en pacientes en estadio terminal por fracaso renal. Se efectúa un estudio retrospectivo que comprende 534 pacientes hemodializados, en 5 unidades de hemodiálisis ubicadas en el área metropolitana de Tokio, entre 1980 y 1999. Utilizando un modelo logÍstico multivariante se determinó, en pacientes hemodializados, los factores de riesgo en la génesis de la úlcera isquémica del pie. Se compararon además, los factores de prevalencia entre el mal perforante plantar de los diabéticos hemodializados, con 61 pacientes diabéticos, homologables por lo que al sexo y edad se refiere, con mal perforante plantar pero que no precisaron hemodiálisis. El modelo logÍstico demostró, la existencia de dos factores de riesgo importantes, por lo que al mal perforante plantar atañe: el fracaso renal diabético [odds ratio=21.580 (95% CI 4.838-96.251), p=0.0001] y los antecedentes de enfermedad cerebro-vascular [odds ratio=2.782 (1.015–7.624), p=0.0467]. Comparando con pacientes control, homologables por lo que a la edad y sexo se refiere, constatamos que en los pacientes hemodializados es más frecuente la asociación de diabetes, enfermedad cerebro-vascular e hipertensión. El desarrollo del mal perforante plantar en el estadio final de pacientes con fracaso renal, viene propiciado por la grave microangiopatÍa diabética, asÍ como por otros factores tales como: secuelas de la enfermedad cerebro-vascular y el mal estado general del paciente.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Johnson BL. Glickman MH, Bandyk DR et al. Failure of foot salvage in patients with end-stage renal disease after surgical revascularization. J. Vase. Surg. 1995;22:280–285

    Article  CAS  Google Scholar 

  2. Pletonen S, Biancari F, Lindgren L. et al. Outcome of infrainguinal bypass surgerv for critical leg ischaemia in patients with chronic renal failure. Eur. J. Vase. Endovasc. Surg. 1998;15:122–127

    Article  Google Scholar 

  3. Edwards JM, Tavlor LM, Porter JM. Limb salvage in end-stage renal disease (ESRD). Arch. Surg. 1988;123:1164–1168

    PubMed  CAS  Google Scholar 

  4. Sanchez LA, Goldsmith J. Rivers SP, et al. Limb salvage surgey in end stage renal disease: is it worthwhile? J. Cardiovasc. Surg. 1992;33:344–348

    CAS  Google Scholar 

  5. Dietzed AM, Sushil KG, Kram HB, et al. Limb loss with patent infra-inguinal bypasses. Eur. J. Vase. Surg. 1990;4:413–417

    Article  Google Scholar 

  6. Wheeler DC. Cardiovascular disease in patients with chronic renal failure. Lancet 1996;348:1673–1674

    Article  PubMed  CAS  Google Scholar 

  7. Lindner A, Charra B, Sherrard DJ, et al. Accelerated atherosclerosis in prolonged maintenance. N. Engl. J. Med 1974;290:697–701

    PubMed  CAS  Google Scholar 

  8. Burke JF Jr, Francos GC, Moore LL, et al. Accelerated atherosclerosis in chronic-dialysis patients-another look. Nephron 1978;21:181–185

    Article  PubMed  Google Scholar 

  9. Jüngers P, Khoa TN, Massy ZA, et al. Incidence of atherosclerotic arterial occlusive accidents in predialysis and dialysis patients: a multicentric study in the Ile de France district. Nephrol. Dial. Transplant. 1999;14:898–902

    Article  PubMed  Google Scholar 

  10. Mailloux LU, Bellucci AG, Mossey RT, et al. Predictors of survival in patients undergoing dialysis. Am. J. Med. 1988;84:855–862

    Article  PubMed  CAS  Google Scholar 

  11. Leers SA, Reifsnyder T, Delmonte R, et al. Realistic expectations for pedal bypass grafts in patients with end-stage renal disease. J. Vase. Surg. 1998;28:976–980

    Article  CAS  Google Scholar 

  12. Webb AT, Franks PJ, Reaveley DA, et al. Prevalence of intermittent claudication and risk factors for its development in patients on renal replacement therapy. Eur. J. Vase. Surg. 1993;7:523–527

    Article  CAS  Google Scholar 

  13. Lindbom A. Arteriosclerosis and arterial thrombosis in the lower limb: roentgenological study. Acta Radiol. (Suppl.) 1950;l-80

    Google Scholar 

  14. Rosen H, Friedman SA, Raizner AE, et al. Azotemic arteriopathy. Am. Heart J. 1972;84:250–255

    Article  PubMed  CAS  Google Scholar 

  15. Ibels LS, Stewart JH, Mahony JF, et al. Occlusive arterial disease in uraemic and haemodialysis patients and renal transplant recipients: a study of the incidence of arterial disease and of the prevalence of risk factors implicated in the pathogenesis of arteriosclerosis. Q. J. Med. 1977;46:197–214

    PubMed  CAS  Google Scholar 

  16. Bergesio F, Ciuti R, Salvadori M, et al. Are lipid abnormalities reliable cardiovascular risk factors in dialvsis patients? Int. J. Artif. Organs 1989;12:677–682

    PubMed  CAS  Google Scholar 

  17. Burdick L, Periti M, Salvaggio A, et al. Relation between carotid arterv atherosclerosis and time on dialvsis: a non-invasive studv in vivo. Clin. Nephrol. 1994;42:121–126

    PubMed  CAS  Google Scholar 

  18. Blacher J, Guierin AP, Pannier B, et al. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434–2439

    PubMed  CAS  Google Scholar 

  19. Parfitt AM. Soft-tissue calcification in uremia. Arch. Intern. Med. 1969;124:544–556

    Article  PubMed  CAS  Google Scholar 

  20. Cressman MD, Heyka RJ, Paganini EP, et al. Lipoprotein(a) is an independent risk factor for cardiovascular disease in hemodialysis patients. Circulation 1992;86:475–482

    PubMed  CAS  Google Scholar 

  21. Babazono T, Miyamae M, Tomonaga O, et al. Cardiovascular risk factors in diabetic patients undergoing continuous ambulatory peritoneal dialysis. Adv. Perit. Dial. 1996;12:120–125

    PubMed  CAS  Google Scholar 

  22. Dionisio P, Caramello E, Bergia R, et al. Atherogenic risk in patients undergoing regular dialysis treatment: improvement of lipid pattern and lipoproteins by polyunsaturated omes;a-3 fatty acids. Nephrol. Dial. Transplant. 1994;9:458

    PubMed  CAS  Google Scholar 

  23. Hahn R, Oette K, Mondorf H, et al. Analysis of cardiovascular risk factors in chronic hemodialysis patients with special attention to the hyperlipoproteinemias. Atherosclerosis 1983;48:279–288

    Article  PubMed  CAS  Google Scholar 

  24. Charney DI, Walton DF, Cheung AK. Atherosclerosis in chronic renal failure. Curr. Opin. Nephrol. Hypertens. 1993;2:876–882

    Article  PubMed  CAS  Google Scholar 

  25. Chang BB, Paty PSK, Shah DM, et al. Results of infrainguinal bypass for limb salvage in patients with end-stage renal disease. Surgery 1990;108:742–746

    PubMed  CAS  Google Scholar 

  26. Painter P, Zimmerman SW. Exercise in end stage renal disease. Am. J. Kidney Dis. 1986;7:386–394

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Teikyo University Ichihara Hospital, 3426-3 Anesaki, Ichihara City, 299-0111, Chiba, Japan

    Hiroshi Yasuhara M.D., Shuji Naka M.D. & Hironobu Yanagie M.D.

  2. Department of Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, 113, Tokyo, Japan

    Hirokazu Nagawa M.D.

Authors
  1. Hiroshi Yasuhara M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shuji Naka M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hironobu Yanagie M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hirokazu Nagawa M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hiroshi Yasuhara M.D..

Additional information

Published Online: July 22, 2002

Published Online: September 26, 2002

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yasuhara, H., Naka, S., Yanagie, H. et al. Influence of diabetes on persistent nonhealing ischemic foot ulcer in end-stage renal disease. World J. Surg. 26, 1360–1364 (2002). https://doi.org/10.1007/s00268-002-6335-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-002-6335-3

Keywords

Search

Navigation