Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes

OBJECTIVE - The objective of this study was to evaluate the association between foot ulcers (DFU) and lower-extremity amputation (LEA) and chronic kidney disease (CKD) in patients with diabetes. RESEARCH DESIGN AND METHODS - This was a retrospective cohort study of individuals enrolled between 2002 and 2006 who were aged >= 35 years, had a history of diabetes, and were cared for in general practice. The physicians participated in The Health information Network of the U.K. RESULTS - The presence of DFU or LEA and estimated glomerular filtration rate (eGFR) were evaluated in 90,617 individuals with a median time of observation of 2.4 years. Of these individuals 378 had an LEA and 2,619 had a DFU, CKD (eGFR <60 ml/min per 1.73 m(2)) was noted in 23,350 (26%) individuals in our cohort. For the development of DFU compared with our reference group (group 1 [eGFR >= 60 ml/min per 1.73 m(2)]), the hazard ratio (HR) for group 2 (eGFR >= 30 and <60 ml/min per 1.73 m(2)) was 1.85 (95% CI 1.71-2.01) and for group 3 (eGFR <30 ml/min per 1.73 m(2)) was 3.92 (3.23-4.75) (all P < 0.001). For LEA, the FIR for group 2 was 2.08 (1.68-2.58) and for group 3 was 7.71 (5.29-11.26) (all P < 0.001). CONCLUSIONS - In this observational study, there is a strong association between stage of CKD and DFU or LEA that is probably not just related to the presence of peripheral arterial disease. Individuals with even moderate CKD (eGFR <60 ml/min per 1.73 m(2)) have an increased risk for DFU and LEA.