Abstract: SA-PO167
A European Hemodialysis Multicenter Implementation of a Standardized Diabetic Foot Examination Protocol
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
- Kleophas, Werner, DaVita Germany, Dusseldorf, Germany
- Drozdz, Maciej B., DaVita Poland, Krakow, Poland
- Brzosko, Szymon, DaVita Poland, Bialystok, Poland
- Frazao, Joao M., Nephrology and Infectiology Research and Development Group, INEB, and School of Medicine, Porto University, Portugal, Porto, Portugal
- Silva, Fatima Ferreira, DaVita Portugal, Alfragide, Portugal
- Alsuwaida, Abdulkareem, King Saud University, Riyadh, Saudi Arabia
- Krishnan, Mahesh, DaVita, Inc, Denver, Colorado, United States
- Jacobson, Stefan H., Danderyd Hospital, Stockholm, Sweden
Background
Diabetics on hemodialysis (HD) have an increased risk for foot ulcers (FU), infections, and limb amputation. Pain and other symptoms are often reduced due to neuropathy resulting in late diagnosis. We assessed the frequency of foot complications following implementation of a standardized foot examination in a cohort of prevalent diabetic HD patients in 26 DaVita centers in Germany, Poland and Portugal. We analyzed differences and associations with demographic data, practices and laboratory data.
Methods
A standardized foot examination was performed in 1025 diabetic HD patients in Germany (n=674), Poland (n=179) and Portugal (n=172). The examination includes: previous FU, amputation etc; inspection of feet (skin, nails); examination of pedal pulses (a dorsalis pedis and tibialis posterior) and foot sensory level. Foot complications were classified according to Wagner (grade 0-5); PAD was classified by clinical pulse measurement (normal=0, weak=1, missing=2).
Results
Mean (SD) patient age was 70.4 (14) years (NS between countries). 8.7% had a prior amputation; this was less common in Germany (p<0.001). A normal pulse in left and right a dorsalis pedis was present in 45% and 44% of patients, respectively, pulses were absent in 33% and 34% (p<0.001 between countries). For left and right a tibialis posterior, normal pulse was present in 37% and 37% of patients, respectively, pulses were absent in in 43% and 42% (p<0.001 between countries). Wagner classification score was 0 or 1 in 95.5% of patients and 4-5 in 1.8% (NS between countries). In a subgroup of 351 patients from Poland and Portugal there were no significant correlations between Wagner score and age, sex, BMI, Kt/V, vascular access, Charlson comorbidity index, Hb, albumin, phosphorus, and PTH. Patients with skin edema were older (p<0.05), had higher Charlson comorbidity index (p<0.05), lower Hb (p<0.05), lower albumin (p=0.01) and higher phosphorus (p=0.004).
Conclusion
Implementation of a standardized foot examination protocol in a large cohort of European diabetic patients on HD revealed a high prevalence of clinically significant complications that warrant close attention. This simple clinical tool is suitable to identify patients at high risk and could be the basis of a program to improve health outcomes.
Funding
- Commercial Support – DaVita, Inc