Long term outcomes of diabetic haemodialysis patients with critical limb ischemia and foot ulcer.
OBJECTIVE
To evaluate the outcomes of diabetic dialysis patients with critical limb ischemia and foot ulcer.


METHODS
The study group included 599 diabetic, 99 dialyzed (Ds) (16.5%) and 500 not dialyzed (NDs) (83%) patients with critical limb ischemia and foot ulcers identified as stage C (ischemia) or D (ischemia plus infection) of Texas Wound Classification. All patients were treated by endovascular revascularization. Outcomes were expressed as healing, major amputation, death and non healing after 12months. The mean follow-up was 15±13months.


RESULTS
The outcomes of the whole population were: 48.9% healing, 11.3% major amputation, 12.7% death, 27.1 non healing. At the multivariate analysis dialysis was a negative predictor of healing and a positive predictor of major amputation. Outcomes for Ds and NDs were respectively: healing (30.3 vs 52.6%), major amputation (14.4 vs 10.8%), death (21.1 vs 11%) and non-healing (34.2 vs 25.6%) (X=0.0004). Amputation occurred earlier in Ds than in NDs. According to the multivariate analysis in Ds ischemic heart disease and lower ΔTcPO2 were negative predictors for healing. Successful revascularization was a negative predictor for major amputation. HDL and carotid artery disease were predictive factors of death among NDs. Among Ds high blood pressure values were the only predictor of amputation while no variable resulted predictive of healing or death.


CONCLUSIONS
Our study shows that our limb salvage protocol ensures a good rate of limb salvage in Ds even if they have a higher risk of amputation and death compared to NDs.
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy. Electronic address: meloni.marco@libero.it.
Marco
M
Meloni
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Laura
L
Giurato
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Valentina
V
Izzo
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Matteo
M
Stefanini
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Enrico
E
Pampana
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Roberto
R
Gandini
University of Tor Vergata, Viale Oxford 81, Rome 00133, Italy.
Luigi
L
Uccioli
D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002985:Clinical Protocols / Q000592:standards; D003920:Diabetes Mellitus; D003925:Diabetic Angiopathies / Q000150:complications / Q000209:etiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D023821:Limb Salvage / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis / Q000401:mortality / Q000706:statistics & numerical data*; D013781:Texas; D016896:Treatment Outcome; D014945:Wound Healing
Critical limb ischemia; Diabetes; Diabetic foot; Dialysis; Limb salvage