J Med Assoc Thai 2018; 101 (11):1583-9

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Prevalence and Risk Factor of Diabetic Foot Syndrome in Diabetic Kidney Patients
Boonyakrai C Mail, Chukaew S

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 filtration 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 classified 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 significant 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 significant 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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