Renal function is highly associated with podiatric risk in diabetic patients

Area of Science:

• Nephrology
• Diabetology
• Podiatry

Background:

• Diabetic foot ulcers (DFU) are a significant complication in diabetes mellitus.
• Chronic kidney disease (CKD) is a known comorbidity associated with an increased incidence of DFU.
• The International Working Group on the Diabetic Foot (IWGDF) provides a classification system for DFU risk factors.

Purpose of the Study:

• To investigate the association between the IWGDF DFU risk classification and estimated glomerular filtration rate (eGFR) levels in patients with diabetes.
• To explore this relationship specifically in non-dialysis CKD patients.
• To identify factors contributing to podiatric risk in the diabetic population.

Main Methods:

• A prospective, multicentric study involving patients from diabetology and nephrology departments.
• Data collection included patient demographics, diabetes duration, IWGDF risk classification, and eGFR.
• Statistical analysis was performed to assess the correlation between eGFR and podiatric risk stages, including subgroup analysis excluding dialysis patients.

Main Results:

• A significant inverse correlation was observed between eGFR levels and higher IWGDF podiatric risk stages (≥2).
• Patients with podiatric risk stage ≥2 had significantly lower mean eGFR compared to those with lower risk stages (36.8 vs 71.9 mL/min/1.73 m²).
• An eGFR cutoff of 45 mL/min/1.73 m² was identified as a discriminant factor for higher podiatric risk (stage ≥2) with an AUC of 0.76.

Conclusions:

• Estimated glomerular filtration rate (eGFR) levels are significantly associated with podiatric risk stages in patients with diabetes mellitus.
• Patients with diabetes and CKD, particularly those with eGFR < 45 mL/min/1.73 m² or on dialysis, require careful management.
• Collaboration with specialized diabetic foot centers is crucial for managing high-risk CKD patients to prevent DFU complications.