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Poor prognosis after lower-limb amputation irrespective of diabetes status in patients undergoing hemodialysis

Akira Tamaki1,2, Mineaki Kitamura1,2, Kosei Yamaguchi1,2

  • 1Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Therapeutic Apheresis and Dialysis : Official Peer-Reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
|November 4, 2022
PubMed

Insights

Patients undergoing hemodialysis with lower-limb amputation have a poor prognosis. Diabetes mellitus negatively impacts survival in hemodialysis patients without amputation but improves survival in those with amputation.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Endocrinology

Background:

  • Diabetes mellitus is a significant risk factor for lower-limb amputation in patients on hemodialysis.
  • The impact of diabetes on survival post-amputation in this population remains unclear.

Purpose of the Study:

  • To investigate the influence of diabetes mellitus on survival outcomes in patients undergoing hemodialysis who have undergone lower-limb amputation.
  • To compare survival rates between patients with and without diabetes in both amputation and control groups.

Main Methods:

  • A retrospective cohort study including patients who underwent lower-limb amputation since 1996 (amputation group) and patients on hemodialysis during 2011-2012 (control group).
  • Follow-up extended until July 2022 to assess survival outcomes.
  • Statistical analysis using hazard ratios (HR) to compare survival between groups.

Main Results:

  • The amputation group (70 patients) had a significantly poorer prognosis (HR: 2.41, p < 0.001) compared to the control group (328 patients).
  • In the control group, diabetes was associated with poorer survival (HR: 1.86, p < 0.001).
  • Conversely, in the amputation group, diabetes was associated with improved survival (HR: 0.47, p = 0.02).

Conclusions:

  • Lower-limb amputation in hemodialysis patients is associated with a poor prognosis, regardless of diabetes status.
  • Diabetes has a detrimental effect on survival for hemodialysis patients without amputation but appears to have a protective effect for those with amputation.
Abstract

Keywords:
diabetes mellitushemodialysislower-limb amputationperipheral artery disease

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