title: Comparison of the risk of non-traumatic lower extremity amputation between haemodialysis and peritoneal dialysis patients with end-stage renal disease.
abstract: OBJECTIVE
  We used insurance claims data of Taiwan to compare the risk of non-traumatic lower extremity amputation between haemodialysis (HD) and peritoneal dialysis (PD) patients.
  
  
  METHODS
  We identified 77 669 HD patients and 10 035 PD patients without prior amputation from 2000 to 2010. Incidence rates and hazard ratios (HRs) of lower extremity amputation, and subsequent 30-day mortality after amputation were evaluated up to 31 December 2011.
  
  
  RESULTS
  There were 2427 and 216 patients undergoing lower extremity amputation during follow-up in the HD and PD groups with incidence rates of 8.35 and 5.79 per 1000 person-years, respectively. Compared with the HD group, the overall adjusted HR of lower extremity amputation for the PD group was 1.27 (95% CI = 1.10-1.46). The impact of diabetes status on the risk of lower extremity amputation interacted with dialysis modality significantly (P < 0.001). Compared with the corresponding HD patients, the PD patients with diabetes had an adjusted HR of 1.44 (95% CI = 1.24-1.67) for amputation, whereas those without diabetes had an adjusted HR of 0.58 (95% CI = 0.36-0.95). The subsequent 30-day mortality rates after amputation were not significantly different between the HD and PD groups (8.45% vs. 9.72%) with an adjusted odds ratio of 1.41 (95% CI = 0.87-2.28, PD versus HD).
  
  
  CONCLUSIONS
  Compared with corresponding HD patients, the amputation risk is higher for PD patients with diabetes, while the risk is lower for PD patients without diabetes. Dialysis patients have a high 30-day mortality risk after amputation.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan.|Department of Internal Medicine, China Medical University College of Medicine, Taichung, Taiwan.|Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Division of Cardiology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chung-Ho
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Orthopedic Surgery, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chun-Hao
authors.initials: CH
authors.lastname: Tsai
authors.affiliation: Division of Cardiology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Sheng
authors.initials: SS
authors.lastname: Chang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Shih-Yi
authors.initials: SY
authors.lastname: Lin
authors.affiliation: Division of Nephrology, Yun-Lin Branch, National Taiwan University Hospital, Yun-Lin, Taiwan.
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.affiliation: Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan.|Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|Department of Health Services Administration, China Medical University, Taichung, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000067575:Administrative Claims, Healthcare; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects / Q000401:mortality; D015897:Comorbidity; D016208:Databases, Factual; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D013997:Time Factors
keywords: Amputation; and peritoneal dialysis; end-stage renal disease; haemodialysis; mortality