Chiropody may prevent amputations in diabetic patients on peritoneal dialysis.
BACKGROUND
A multidisciplinary approach has been shown to be of benefit in the prevention of lower limb ulceration and amputation in patients with diabetes, but there is less information on the role of such an approach in patients receiving dialysis treatment.


OBJECTIVE
The purpose of the present study was to determine whether the institution of a chiropody program would result in fewer amputations in diabetic patients on peritoneal dialysis (PD).


METHODS
Retrospective chart review.


METHODS
The PD program at a tertiary-care hospital.


METHODS
Patients with diabetes that were enrolled in the PD program between January 1997 and December 1999, inclusive, that were offered the opportunity to see a chiropodist, and that agreed to be seen. A total of 132 patients were included.


METHODS
Education about foot care, assessment, and, in some instances, treatment by a chiropodist.


RESULTS
Patients with an amputation were more likely to be male (p < 0.01) and have peripheral vascular disease (p < 0.001) compared to those without an amputation. They also had a lower average mean arterial pressure (p < 0.05), lower weekly creatinine clearance (p < 0.01), higher mean erythropoietin dose (p < 0.05), and longer duration of end-stage renal disease (p < 0.001). Factors that were predictive of shorter time to death or amputation were older age [hazard ratio (HR) = 1.03, p < 0.05], peripheral vascular disease (HR = 2.66, p< 0.01), and cerebrovascular disease (HR = 2.70, p< 0.01). Being seen by a chiropodist was protective (HR = 0.39, p < 0.01).


CONCLUSIONS
The current study suggests that a chiropody program may help to prevent amputation in patients with diabetes on PD.
Lipscombe
Jennifer
J
Division of Nephrology, University Health Network, Toronto, Ontario, Canada.
Jassal
Sarbjit V
SV
Bailey
Susan
S
Bargman
Joanne M
JM
Vas
Stephen
S
Oreopoulos
Dimitrios G
DG
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000150:complications / Q000517:prevention & control* / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011032:Podiatry; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index