Abstract
BackgroundAdults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation. However, the risk factors for foot ulceration in the dialysis population are incompletely understood due to the lack of high-quality prospective evidence. This article outlines the design of a prospective observational cohort study, which aims to investigate the risk factors for foot ulceration in adults on dialysis.Methods/DesignThis study will recruit 430 participants with end-stage renal disease on dialysis from satellite and home-therapy dialysis units across multiple health organisations in Melbourne, Victoria, Australia. Data collection at baseline will include a participant interview, medical record review, completion of a health-status questionnaire and a non-invasive foot assessment. Twenty participants will also be recruited to a reliability study to evaluate the reproducibility of testing procedures. Primary outcome data includes: new foot ulcer(s). Secondary outcome data includes: number of new foot ulcers, time to onset of new foot ulcer(s), new lower extremity amputation(s), episodes of infection of the foot or lower extremity, episodes of osteomyelitis, foot-related hospitalisations, revascularisation procedure(s) of the lower extremity, new podiatry interventions, kidney transplantation, and mortality. Participants will be assessed at baseline, and at 12 months they will be evaluated for the primary and secondary outcomes. Multivariate Cox proportional hazards models will be used to assess predictors of new foot ulceration and time to event secondary outcomes. Logistic regression will be used for binary outcomes including prevalence of foot ulcerations.DiscussionThis is the first multi-centre prospective observational cohort study to investigate risk factors for foot ulceration in adults with end-stage renal disease on dialysis. This study will improve on prior studies by using prospective methods, multi-centre recruitment, statistical methods to control for confounding variables, and a pre-specified sample size estimation. The findings can inform the design of future trials evaluating the effectiveness of clinical interventions, which may lead to improved patient outcomes in the dialysis setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0110-9) contains supplementary material, which is available to authorized users.
Highlights
Adults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation
A recent study [23] conducted in the United States reported the annual cost of diabetic foot ulceration on public and private payers is between US$9 - $13 billion, not including the costs associated with diabetes management itself
Despite the high prevalence of foot ulceration in the dialysis population, there is a paucity of highquality prospective studies that have investigated the risk factors associated with this condition
Summary
Adults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation. End-stage renal disease (ESRD) is a global public health problem characterised by a significant loss in kidney function, causing retention of metabolic waste products, salt and fluid in the body [1] The accumulation of these waste products can become fatal unless renal replacement therapy (i.e. dialysis or kidney transplantation) is sought. It is Adults with ESRD on dialysis are at high risk for foot ulceration and subsequent lower extremity amputation [4,5,6,7,8,9,10,11,12]. A recent study [23] conducted in the United States reported the annual cost of diabetic foot ulceration on public and private payers is between US$9 - $13 billion, not including the costs associated with diabetes management itself
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