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Abstract: SA-PO1038

Standardized Clinical Foot Examination in Prevalent Diabetic Hemodialysis Patients: Association with Mortality and Hospitalization

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Brzosko, Szymon, DaVita Poland, Bialystok, Poland
  • Drozdz, Maciej, DaVita International, London, United Kingdom
  • Frazao, Joao M., Davita Portugal, Amadora, Portugal
  • Silva, Fatima Ferreira, Davita Portugal, Amadora, Portugal
  • Kleophas, Werner, DaVita Deutschland, Dusseldorf, Germany
  • Das, Partha, DaVita International, London, United Kingdom
  • Jacobson, Stefan H., Karolinska Institutet, Stockholm, Sweden

Group or Team Name

  • DaVita International
Background

Atherosclerosis, neuropathy and SHPT contribute to increased risk of peripheral vascular disease (PVD) and adverse outcomes (eg, ulcers, limb amputation, hospitalizations and mortality) in diabetic patients on HD. Both the ACC/AHA and KDIGO guidelines recommend screening of individuals at risk. This study analyzed the frequency of foot complications following implementation of a standardized foot examination in 345 prevalent diabetic HD patients in 12 DaVita centers in Poland (n=177 pts) and Portugal (n=168 pts). Hospitalizations and cause-specific mortality were documented during 24 months follow up.

Methods

The protocol includes: history of the patient (ulcers, amputation), inspection of feet (skin, nails) and examination of the pedal pulses (a dorsalis pedis and a tibialis posterior) Foot complications were classified according to Wagner (grade 0-5) and PVD was classified by pulse measurement (normal vs weak or missing). We analyzed risks associated with hospitalization and mortality using Cox proportional hazard models.

Results

Mean age of patients (58% men) was 70.4 (SD 14) yrs. A normal pulse in L and R a dorsalis pedis and in L and R a tibialis post was found in 17% and 10% of patients, respectively. All other patients had weak or absent pulses. The Wagner score was 0 or 1 in 88% of patients, 2-3 in 6%, and 4-5 in 5%. All-cause mortality was 31% during the 2 year follow up. 71% of patients had at least one hospital stay. Cardio-cerebrovascular disease, PVD, and infection accounted for 76% of all mortality. In unadjusted analyses presence of weak or absent pulses in a dorsalis pedis was significantly associated with all-cause mortality RR 2.1 (CI 1.1-4.3; p<0.05). In adjusted models including age, sex, Hb, albumin, Kt/V, vascular access, phosphorus, PTH and Charlson score, only albumin was associated with mortality (RR 0.89, CI 0.84-0.94; p<0.001) and risk of hospitalization (RR 0.92, CI 0.89-0.96; p<0.001).

Conclusion

Implementation of a standardized foot examination protocol in diabetic patients on HD showed a high prevalence of clinically significant complications that warrant close attention. This clinical tool is suitable to identify patients at high risk of future complications and could be the basis of a program to improve overall health outcomes.