The impact of creatinine clearance on the outcome of diabetic foot ulcers in north Indian tertiary care hospital.
OBJECTIVE
Wound healing has been reported to be poor in diabetic patients with impaired kidney functions that usually accompanies retinopathy and neuropathy. The insensitive foot is vulnerable to repeated trauma and development of ulcer precedes 70-80% of non-traumatic lower extremity amputation. The present study was aimed to study the impact of creatinine clearance (CCre) on the outcome of diabetic foot ulcers (DFU).


METHODS
Data from 162 DFU patients admitted to Rajiv Gandhi Centre for Diabetes and Endocrinology of J.N. Medical College, Aligarh Muslim University, Aligarh, India, between December 2009 and March 2011 were analyzed. Detailed history and patient's profile, grade of DFU, co-morbidities and complications, laboratory data, microbiological profile and final outcome were collected. CCre was calculated according to MDRD formula.


RESULTS
The study revealed that, DFU healing was worst in patients with decreased CCre than in those who had normal CCre. Other factors associated with poor outcome were, higher grade of ulcer, infection type (subcutaneous and osteomyelitis) and biofilm infection. Amputation rates were also found to be higher in those with poor renal functions.


CONCLUSIONS
The results suggest that CCre is an important factor affecting wound healing in patients with DFUs. The automatic reporting of eGFR each time a serum creatinine concentration is requested will increase the awareness of significant kidney dysfunction in clinical practice especially in DFU patients and appropriate measures will improve the outcome.
Department of Microbiology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India.
Mohammad
M
Zubair
Abida
A
Malik
Jamal
J
Ahmad
D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D003404:Creatinine / Q000097:blood*; D017719:Diabetic Foot / Q000097:blood* / Q000628:therapy; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000628:therapy; D062606:Tertiary Care Centers; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D003404:Creatinine