Abstract
Background: We evaluated whether, in subjects receiving haemodialysis (HD), the presence of diabetic foot syndrome (DFS) was associated with increased mortality compared with subjects with diabetes mellitus (DM) without DFS and with non-diabetic subjects. Methods: Retrospective, observational study in 220 subjects followed for six years. We calculated and compared the frequency and 5-year cumulative incidence of all-cause mortality, cardiovascular (CV) mortality, CV events, major adverse CV events (MACE), and new foot ulcer (FU) or amputation. We also examined prognostic factors of all-cause and CV mortality based on baseline characteristics. Results: DM patients had a 1.98 times higher probability of all-cause mortality than those without DM (p = 0.001) and 2.42 times higher likelihood of CV mortality and new FU or amputation (p = 0.002 and p = 0.008, respectively). In the DM cohort, only the risk of a new FU or amputation was 2.69 times higher among those with previous DFS (p = 0.021). In patients with DM, older age was the only predictor of all-cause and CV mortality (p = 0.001 and p = 0.014, respectively). Conclusions: Although all-cause and CV mortality were increased on HD subjects with DM, the presence of DFS did not modify the excess risk. Additional studies are warranted to further explore the impact of DFS in subjects with DM undergoing HD.
Highlights
Diabetes mellitus (DM) is the primary cause of chronic kidney disease (CKD) and, alone or in combination with hypertension, the cause of 80% of end-stage renal disease (ESRD) cases [1]
Previous or current diabetic foot syndrome (DFS) was found in 35.3% of patients from the overall diabetic HD population, and clinical history of foot ulcer (FU)
It was unexpected that the rates of all-cause and CV mortality, major adverse CV events (MACE), or CV events were similar between patients with and without DFS
Summary
Diabetes mellitus (DM) is the primary cause of chronic kidney disease (CKD) and, alone or in combination with hypertension, the cause of 80% of end-stage renal disease (ESRD) cases [1]. The already high risk in the 10-year cumulative allcause mortality for DM increases by 20% when accompanied by CKD [1]. The reasons for this increased mortality include the presence of significant cardiovascular disease (CVD), problems with vascular access, increased susceptibility to infectious complications, haemodynamic instability during HD due to autonomic neuropathy, and foot ulcer (FU) [2]. The mortality of patients requiring chronic dialysis is higher among subjects with DM, with an estimated 5-year survival as low as 30% after initiation of haemodialysis (HD) [2]. Additional studies are warranted to further explore the impact of DFS in subjects with
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