Abstract: TH-PO453
Clinical Features of Dialysis Patients at Risk of Lower Limb Amputation
Session Information
- Hypertension and CVD: Epidemiology, Risk Factors, Prevention
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Butler, Karen G., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- O'Connell, Michael Ryan, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Chaudhuri, Sheetal, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Han, Hao, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Dugan, Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Ketchersid, Terry L., Fresenius Medical Care North America, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background
Dialysis patients are at elevated risk for peripheral artery disease (PAD), lower extremity ulcers, and lower limb amputations (LLA) (Garimella et al, 2017). As part of a quality improvement project for the current foot check process, a large dialysis provider piloted a Limb Preservation Project (LPP) capturing clinical features of patients’ limbs at risk for amputation to streamline processes for specialist referral. We analyzed what features were more common in patients with LLA.
Methods
LPP was deployed at 9 dialysis clinics during Sept 2017 to Jan 2018. Dialysis clinics received a monthly list of patients considered high risk for foot ulcer who then received screening for dermatologic, mechanical and vascular changes in lower extremities.
Results
Among 571 patients considered high risk, there were 458 remarkable features documented. In those without a prior amputation (n=496), there were 356 features documented, and for those with a prior amputation (n=75), 102 were features documented. Patients with a prior amputation most frequently had bandaged wound on their non-amputated limb (23.53%), an open wound/ulcer on their amputated limb (18.63%), and abnormal nails (11.76%). Patients without a prior amputation most frequently had abnormal nails (36.25%), skin cracks/fissures (16.01%), and a bandaged wound (10.11%).
Conclusion
Results suggest that regardless of amputation status, the presence of abnormal nails and bandaged wounds may be a common clinical feature in dialysis patients at risk of lower extremity vascular disease.
| Figure 1: Clinical Features | # of Features for Patients without Amputation | % of Features for Patients without Amputation | # of Features for Patients with Amputation | % of Features for Patients with Amputation | Odds Ratio |
| Skin cracks/fissures on amputated limb(s) | 0 | 0.00% | 9 | 8.82% | 0 |
| Vascular insufficiency with skin and/or temperature changes on amputated limb(s) | 0 | 0.00% | 6 | 5.88% | 0 |
| Open wound/ulcer on amputated limb(s) | 0 | 0.00% | 19 | 18.63% | 0 |
| Abnormal nails/nail care needed | 130 | 36.52% | 12 | 11.76% | 3.11 |
| Poorly fitting shoes | 4 | 1.12% | 0 | 0.00% | Infinity |
| Skin cracks/fissures | 57 | 16.01% | 10 | 9.80% | 1.64 |
| Change in foot/leg skin color | 34 | 9.55% | 6 | 5.88% | 1.62 |
| Temperature difference between calves and feet or between the left and right foot | 17 | 4.78% | 3 | 2.94% | 1.62 |
| Vascular-related pain on walking/claudication | 25 | 7.02% | 0 | 0.00% | Infinity |
| Open wound/ulcer | 35 | 9.83% | 11 | 10.78% | 0.91 |
| Red, hot, swollen midfoot or ankle | 5 | 1.40% | 1 | 0.98% | 1.42 |
| Dry or wet gangrene | 6 | 1.69% | 1 | 0.98% | 1.72 |
| Inflammation over a corn, callus, bunion, hammertoe or bony prominence | 7 | 1.97% | 0 | 0.00% | Infinity |
| Bandage/dressing in place over an active wound | 36 | 10.11% | 24 | 23.53% | 0.43 |