Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective.
BACKGROUND
End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis.


OBJECTIVE
The study aims to document trends in the prevalence and identify risk factors of non-traumatic LLA in Australian patients on dialysis.


METHODS
A retrospective review of all patients (218) who attended the regional dialysis center between 1st January 2009 and 31st December 2013 was conducted. Demographic, clinical and biochemical data were analyzed.


RESULTS
We identified a high prevalence of 13.3% of LLAs amongst Australian patients with ESRF on dialysis at our center. The associated risk factors were the presence of diabetes (OR 1.67 [1.49-1.88] p < 0.001), history of foot ulceration (OR 81 [18.20-360.48] p < 0.001), peripheral arterial disease (OR 31.29 [9.02-108.56] p < 0.001), peripheral neuropathy (OR 31.29 [9.02-108.56] p < 0.001), foot deformity (OR 23.62 [5.82-95.93] p < 0.001), retinopathy (OR 6.08 [2.64-14.02] p < 0.001), dyslipidemia (OR 4.6 [1.05-20.05] p= 0.049) and indigenous background (OR 3.39 [1.38-8.33] p= 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p < 0.05).


CONCLUSIONS
There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels.
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
Rajit A
RA
Gilhotra
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
Beverly T
BT
Rodrigues
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
Venkat N
VN
Vangaveti
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
George
G
Kan
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
David
D
Porter
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
Kunwarjit S
KS
Sangla
a School of Medicine and Dentistry, James Cook University , Townsville , Australia.
Usman H
UH
Malabu
D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001315:Australia / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D016523:Foot Ulcer / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000453:epidemiology; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D000095283:Australian Aboriginal and Torres Strait Islander Peoples
Australia; dialysis; end-stage renal failure; lower limb amputation