Abstract: FR-PO0441
Routine Foot Examinations in Veterans Affairs (VA) Dialysis Units: A Quality Improvement Initiative to Reduce Amputation Risk
Session Information
- Dialysis: Measuring and Managing Symptoms and Syndromes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Xu, Chang, James J Peters VA Medical Center, New York, New York, United States
- Escoto, Kathleen M, James J Peters VA Medical Center, New York, New York, United States
- Toro, Carlos A, James J Peters VA Medical Center, New York, New York, United States
- Rohatgi, Rajeev, James J Peters VA Medical Center, New York, New York, United States
Background
Major lower limb amputation (MLLA) is a devastating and preventable complication among patients with diabetes undergoing hemodialysis. While monthly foot checks are standard in many private-sector dialysis units, this preventive measure has not been routinely implemented at Veterans Affairs (VA) dialysis units. This quality improvement (QI) project aimed to implement a routine monthly foot check protocol at our VA dialysis unit and to assess its impact on MLLA incidence in diabetic hemodialysis (HD) patients.
Methods
In November 2023, a monthly intradialytic foot check protocol was initiated at our VA dialysis unit. We conducted a pre- and post-implementation comparison of MLLA incidence using two-proportion Z-tests and a Cox proportional hazards regression analysis. Key covariates included age, sex, race, BMI, history of diabetes, medication use, dialysis duration, and relevant laboratory values. Additional correlations between specific laboratory markers and prior MLLA were analyzed using Spearman’s rank correlation.
Results
Between January 2021 and November 2023 (pre-implementation), 9 diabetic HD patients experienced MLLA, yielding an incidence of 5.5 MLLA per 100 patient-years. In contrast, during the first year following implementation (November 2023–2024), none of the 38 diabetic patients who received monthly foot checks experienced MLLA. However, three diabetic patients who did not receive foot checks did undergo MLLA during the same timeframe. The MLLA rate among those non-foot check participants with diabetes was 22.6 MLA per 100 patient-years. The foot check intervention was associated with a 100% reduction in MLLA incidence (p=0.027).
Multivariable adjusted cox regression revealed that routine foot checks significantly reduced the hazard of MLLA by 99.997% (HR=0.003; p<0.001). Correlational analyses showed a positive association between history of MLLA and certain laboratory markers such as Beta-2 Microglobulin, Lipoprotein A, Triglyceride-Glucose Index and ferritin.
Conclusion
Routine monthly foot checks in diabetic HD veterans were associated with a statistically significant reduction in MLLA. This QI initiative demonstrates the value of standardized foot surveillance in improving outcomes for this high-risk population and provides a compelling model for national adoption within VA dialysis units.
Funding
- Veterans Affairs Support