Chiropody may prevent amputations in diabetic patients on peritoneal dialysis

A multidisciplinary approach has been shown to be of benefit in the prevention of lower limb ulceration and amputation in patients with diabetes, but there is less information on the role of such an approach in patients receiving dialysis treatment.

The purpose of the present study was to determine whether the institution of a chiropody program would result in fewer amputations in diabetic patients on peritoneal dialysis (PD).

Retrospective chart review.

The PD program at a tertiary-care hospital.

Patients with diabetes that were enrolled in the PD program between January 1997 and December 1999, inclusive, that were offered the opportunity to see a chiropodist, and that agreed to be seen. A total of 132 patients were included.

Education about foot care, assessment, and, in some instances, treatment by a chiropodist.

Patients with an amputation were more likely to be male (p < 0.01) and have peripheral vascular disease (p < 0.001) compared to those without an amputation. They also had a lower average mean arterial pressure (p < 0.05), lower weekly creatinine clearance (p < 0.01), higher mean erythropoietin dose (p < 0.05), and longer duration of end-stage renal disease (p < 0.001). Factors that were predictive of shorter time to death or amputation were older age [hazard ratio (HR) = 1.03, p < 0.05], peripheral vascular disease (HR = 2.66, p< 0.01), and cerebrovascular disease (HR = 2.70, p< 0.01). Being seen by a chiropodist was protective (HR = 0.39, p < 0.01).

The current study suggests that a chiropody program may help to prevent amputation in patients with diabetes on PD.