Prevalence and Risk Factor of Diabetic Foot Syndrome in
Diabetic Kidney Patients
Chanchana Boonyakrai MD1, Sumitra Chukaew RN1
Affiliation :
1 Department of Medicine, Taksin Hospital, Bangkok, Thailand
Objective : Study the prevalence of diabetic foot disease in those with concurrent renal disease and evaluate risk factor of developing
DFS in consecutive patients with type 1 or 2 diabetes and DKD attending the clinics between 2014 and 2016.
Materials and Methods : Three hundred eighty-four patients were included in the study. Estimated and glomerular (cid:976)iltration rate
[eGFR] were calculated according to CKD-EPI. The patients were grouped into chronic kidney disease [CKD], according to eGFR,
as stage 3, 4, or 5, and were classi(cid:976)ied as either receiving dialysis therapy or not. The foot assessment included diabetic peripheral
neuropathy, peripheral arterial disease, foot ulceration, ankle-brachial index [ABI], and amputation. Risk factors for prevalent foot
ulceration were assessed by logistic regression.
Results : Three hundred eighty-four patients with diabetes and DKD (mean age 63 years: male 41%, female 59%) had type 1 and
2 diabetes staging of DKD performed by urine albumin. Stage 3 was 39.25%, stage 4 was 6.75%, and stage 5 was 4.75%. This
compared to the non-DKD patients that had higher prevalence of DFS at 46.6%, diabetic neuropathy 97.7%, impaired ABI (<0.9)
1.1%, prevalent foot ulceration 5.02%, and intermittent claudication 3.3%. There was a signi(cid:976)icant negative correlation between
eGFR and presence of DFS patients with diabetes (adjusted odd ratio 0.992, p<0.05). Multiple logistic regression analysis revealed
a signi(cid:976)icant association between the presence of skin infection/discharge and DKD stage 4 (odd ratio 3.33, p<0.005). In univariate
analysis, the DFS was related to dialysis treatment, smoking, decline of renal function, high HbA1C, and level of albuminuria.
Conclusion : Poor control of diabetes, dialysis, the degree of renal function impairment, and level of urine albumin were independently
associated with DFS. Therefore, early screening and intensive foot care should be highlighted in the DKD.
Keywords : Diabetic kidney disease, Diabetic foot syndrome, Dialysis, Albuminuria
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