title: High levels of foot ulceration and amputation risk in a multiracial cohort of diabetic patients on dialysis therapy.
abstract: OBJECTIVE
  To evaluate the prevalence of lower-limb complications in a multiracial cohort of patients with diabetes receiving dialysis.
  
  
  METHODS
  This work was a cross-sectional study of lower-limb complications in dialysis-treated patients with diabetes in the U.K. and U.S.
  
  
  RESULTS
  We studied 466 patients (139 U.K.; 327 U.S.). The prevalence of lower-limb complications was high (foot ulcers 12%, neuropathy 79%, peripheral arterial disease 57%, history of foot ulceration 34%, and prior amputation 18%), with no significant ethnic variation, except that foot ulcers were more common in whites than in patients of African descent (P = 0.013). Ninety-five percent of patients were at high risk of lower-limb complications. Prior amputation was related to foot ulcer history, peripheral arterial disease, and hemodialysis modality in multivariable analysis. Prevalent ulceration showed independent associations with foot ulcer history and peripheral arterial disease, but not with ethnicity.
  
  
  CONCLUSIONS
  All patients with diabetes receiving dialysis are at high risk of lower-limb complications independent of ethnic background.
authors.affiliation: Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester National Institute of Health Research Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester,UK. agbor.ako@manchester.ac.uk
authors.forename: Agbor
authors.initials: A
authors.lastname: Ndip
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Lavery
authors.forename: Javier
authors.initials: J
authors.lastname: Lafontaine
authors.forename: Martin K
authors.initials: MK
authors.lastname: Rutter
authors.forename: Anand
authors.initials: A
authors.lastname: Vardhan
authors.forename: Loretta
authors.initials: L
authors.lastname: Vileikyte
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Boulton
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors