Foot gangrene in patients with end-stage renal disease: a case control study.
The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized for foot gangrene according to their renal status (ESRD versus no renal insufficiency). All patients with ESRD hospitalized for foot gangrene (n = 16) from 1996 to 2002 were compared with a control group with normal creatininemia (n = 24) hospitalized for foot gangrene due to peripheral atherosclerotic arterial disease. The 2 groups were matched for age, sex ratio, and number with diabetes mellitus. After a mean follow-up of 467 +/-410 days, patients with ESRD had a more severe prognosis as regards mortality (68.7% vs 12.5%, p = 0.0005) and major amputation (31% versus 8%, p = 0.09). The ESRD group was characterized by more frequent extensive arterial calcifications (16/16 vs 13/24, p = 0.002), owing to a higher level of the calcium phosphorus product (3.54 +/-1.2 vs 2.4 +/-0.6, p = 0.0023), and by impaired microcirculatory perfusion, as indicated by a lower oxygen pressure (TcPO(2)) (15.6 +/-12 mm Hg vs 26 +/-16, p = 0.07). ESRD implies a poor prognosis in patients with stage IV peripheral arterial disease.
Boufi
Mourad
M
Department of Vascular Surgery and Research Unit of CNRS, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France.
Ghaffari
Parinaz
P
Allaire
Eric
E
Fessi
Hafedh
H
Ronco
Pierre
P
Vayssairat
Michel
M
D000368:Aged; D000671:Amputation, Surgical; D050197:Atherosclerosis / Q000150:complications / Q000401:mortality / Q000601:surgery; D016022:Case-Control Studies; D005260:Female; D005528:Foot / Q000473:pathology* / Q000601:surgery; D005734:Gangrene / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D006435:Renal Dialysis; D016019:Survival Analysis