Mortality after amputation in dialysis patients is high but not modified by diabetes status

Schroijen, M.A.; Diepen, M. van; Hamming, J.F.; Dekker, F.W.; Dekkers, O.M.; NECOSAD Study Grp (2020)

Article / Letter to editor

Background: Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis.Methods: Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression).Results: During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3-63.2] and 4.1 (95% CI 2.7-6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8-7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3-6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12).Conclusions: Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.

• amputation
• diabetes mellitus
• dialysis
• mortality
• survival

• All authors: Schroijen, M.A.; Diepen, M. van; Hamming, J.F.; Dekker, F.W.; Dekkers, O.M.; NECOSAD Study Grp
• Date: 2020-12-01
• Journal: Clinical Kidney Journal
• Volume: 13
• Issue: 6
• Pages: 1077 - 1082
• DOI: doi:10.1093/ckj/sfz116
• Link: https://academic.oup.com/ckj/article/13/6/1077/5572833