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Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis

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Abstract

Among the spectrum of risk for diabetic foot disease conferred by chronic kidney disease (CKD), end-stage renal disease (ESRD) has emerged as a novel independent risk factor. Apart from the classical triad of neuropathy, infection, and peripheral arterial disease that operate in these individuals, the risk is further compounded by inadequate foot self-care by patients and by dialysis centers not providing onsite foot care, as medical priorities are diverted to the dialysis itself. Consequently, the burden of diabetic foot disease has increased in the CKD and ESRD population as exemplified by high ulceration, amputation, and foot-related mortality rates. Current guidelines on foot care in diabetes should recognize advanced CKD and ESRD/dialysis as a separate risk factor for foot disease to alert professionals and highlight the opportunity for prevention. Recent studies have demonstrated improved foot outcomes when chiropody programs are instituted within dialysis units.

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Abbreviations

ARIC:

Atherosclerosis Risk in Communities

DOPPS:

Dialysis Outcomes and Practice Patterns Study

HERS:

Heart and Estrogen/Progestin Replacement Study.

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Authors and Affiliations

  1. Diabetes Centre (Department of Medicine), Manchester Royal Infirmary, 193 Hathersage Road, Manchester, M13 0JE, UK

    Agbor Ndip & Andrew J. M. Boulton

  2. Department of Plastic Surgery, University of Texas Southwestern Medical Center, Parkland Hospital, 1801 Inwood Road, Dallas, TX 75930-9132, USA

    Lawrence A. Lavery

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  1. Agbor Ndip
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  2. Lawrence A. Lavery
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  3. Andrew J. M. Boulton
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Correspondence to Agbor Ndip.

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Ndip, A., Lavery, L.A. & Boulton, A.J.M. Diabetic Foot Disease in People with Advanced Nephropathy and Those on Renal Dialysis. Curr Diab Rep 10, 283–290 (2010). https://doi.org/10.1007/s11892-010-0128-0

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