Temporal relationship between chronic kidney disease and the progression of lower limb threatening risk factors
Nia J Jones1, Ian Mathieson1, Paul Hewlett1, Aled O Phillips2 & Stephen G Riley2
1 Cardiff Metropolitan University, School Health Sciences, Western Avenue, Cardiff, UK
2 Institute of Nephrology, University Hospital of Wales, Heath Park, Cardiff, UK
Chronic kidney disease is a growing public health burden. The literature suggests that the haemodialysis population are at risk of foot ulceration and lower limb amputation given that a high proportion has diabetic nephropathy documented as the primary diagnosis (Jones et al. 2013, Kaminski et al. 2015). This research study investigated the progression of lower limb threatening risk factors in a general chronic kidney disease population (Stage ≥4) over a two year period. There was a high incidence of lower limb threatening risk factors documented in this general pre-dialysis cohort (n=101) between baseline and study endpoint; peripheral neuropathy 20%, peripheral arterial disease 21%, and foot ulcer risk 16%. A temporal relationship was observed between chronic kidney disease (Stage ≥4) and the progression of lower limb threatening risk factors in this cohort. This suggests that the risk of foot ulceration and lower limb amputation develops earlier in the natural course of the disease and is not confined to the diabetic nephropathy population. The study findings present a compelling case for introducing a dedicated foot protection program to reduce the burden of these devastating complications in the high risk pre-dialysis population.
Jones N.J., Chess J., Cawley S., Phillips A.O., Riley S.G. 2013. Prevalence of risk factors for foot ulceration in general haemodialysis population. International Wound Journal, 10(6), pp. 683-688
Kaminski M., Raspovic A., McMahon L.P., Strippoli G.F.M., Palmer S.C., Ruospo M., Dallimore S., Landorf K.B. 2015. Risk factors for foot ulceration and lower extremity amputation in adults with end stage renal disease on dialysis: a systematic review and meta-analysis. Nephrology Dialysis Transplantation, 30, pp. 1747-1766.