Abstract: SA-PO166
Trends of Non-Traumatic Lower Extremity Amputation in People with ESRD, by Diabetes Status, United States, 2000-2015
Session Information
- Diabetic Kidney Disease: Clinical - II
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Harding, Jessica L., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Gregg, Edward, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
Background
Non-traumatic lower extremity amputation (NLEA) is a complication of end-stage renal disease (ESRD) and diabetes mellitus (DM). Contemporary trend data on NLEA among people with ESRD are lacking.
Methods
We estimated incident NLEA hospitalizations during 2000-2015 in adults with ESRD from the U.S. Renal Data System. Rates of first NLEA were estimated for any NLEA, minor NLEA (below ankle) and major NLEA (through or above ankle) using ICD-9 procedure codes from January 2000 to September 2015 and ICD-10 from October to December 2015. Hospitalization rates were stratified by primary cause of ESRD (DM or no-DM). Time trends were assessed using Joinpoint regression and annual percent changes (APC) reported.
Results
Among ESRD-DM, age-standardised rates for any NLEA declined 32% (from 36.4 to 24.9 per 1,000 persons) from 2000-2010 (APC= -3.87, p<0.05), and then did not change from 2010-2015 (APC=0.21, p=0.8) (Figure). Major NLEA rates declined 49% throughout the period (APC=-4.98, p<0.05), and minor NLEA rates declined 22% from 2000-2009 (APC=-2.63, p<0.05) and then did not change from 2009-2015 (APC=1.42, p=0.08). Among ESRD-noDM, rates for any NLEA declined 25% (from 5.3 to 4.0 per 1,000 persons) from 2000-2008 (APC=-3.66, p<0.05), and then did not change from 2008-2015 (APC=0.52, p=0.4). Major NLEA rates declined 39% from 2000-2011 (APC=-4.95, p<0.05) and then did not change from 2000-2015 (APC=1.02, p=0.6), and minor NLEA rates did not change from 2000-2008 (APC=-1.31, p=0.08) and then increased 19% from 2008-2015 (APC=2.47, p<0.05).
Conclusion
Despite an initial period of decline, the later stagnation in rates of any NLEA in adults with ESRD seem to be driven by a lack of further declines in minor NLEAs. Increased attention to preventive foot care in the ESRD population might be considered, particularly for those with ESRD-DM where NLEA rates remain almost six times higher than ESRD-noDM.
Figure Age-standardized hospitalization rates for non-traumatic lower extremity amputations (NLEA) among people with ESRD with diabetes (DM) (A) and without diabetes (noDM) (B), United States, 2000-2015