P1044RENAL DIABETIC FOOT: DIFFERENT PATTERNS AND CHARACTERIZATION OF PERIPHERAL ARTERY DISEASE BETWEEN NON-UREMIC AND UREMIC DIABETIC PATIENTS

Abstract

Abstract Background and Aims The diabetic foot (DF) was traditionally considered a local foot problem due to diabetes; however many observations support the concept that the DF is actually a part of a more complex diabetes related syndrome which includes several long-term complications and co-morbidities. In recent years, an increase in the incidence of ischemic diabetic foot ulcers (DFUs) amongst dialyzed subjects has been observed, going up from approximately 5-10% fifteen years ago to the current rate of approximately 30-35%. Today it is well recognized that end stage renal disease (ESRD) is an independent risk factor for non-healing ulcers and amputation in diabetic subjects. In clinical practice, the presence of foot problems in ESRD diabetic patients is identified as a specific entity termed “renal-diabetic foot”. The aim of this study is to describe the angiographic characteristics of peripheral arterial disease (PAD) in patients with DFUs receiving chronic dialysis treatment. Method The study group was composed of patients with DFUs and PAD who referred to our diabetic foot unit. All patients have been managed with a pre-set limb salvage protocol including revascularization of the affected limb. Arterial lesions (stenosis between 50-99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence of dialytic treatment, patients were divided in two subgroups: renal-diabetic foot (RDF) and diabetic foot (DF). Patterns of PAD and immediate revascularization outcome (technical revascularization outcome) for RDF and DF were separately reported and compared Results The demographic and clinical characteristics were reported in Table 1.RDF reported greater number of affected vessels (n= 5±1.6 vs 3.9±1.5, p<0.0001), greater involvement of the superficial femoral artery (90.2 vs 75.8%, p=0.003), tibial-peroneal trunk (53.7 vs 25.5%, p=0.01), anterior tibial artery (93.9 vs 80.9%, p=0.03) and below-the-ankle arteries (70.7 vs 35.7%, p=0.0001) than DF patients. RDF showed a higher rate of revascularization failure (43.9 vs 15.3%, p<0.0001) in comparison to DF patients (Table 2). Below-the-ankle (BTA) arterial disease [OR 9.5 (CI 95% 3.5-25.4) p=0.0001] resulted as the only independent predictor of revascularization failure. Conclusion It was interesting to highlight that the above mentioned findings could be specifically related to the effect of renal disease on the arteries of the lower extremity because the two groups, RDF and DF, did not report any difference in terms of other traditional cardiovascular risk factors (age, smoke, arterial hypertension, dyslipidemia, diabetes duration) which could influence the characteristics of PAD. RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison to DF subjects. BTA arterial disease is an independent predictor of revascularization failure.