Amputations and foot-related hospitalisations disproportionately affect dialysis patients
Amputations and foot-related hospitalisations disproportionately affect dialysis patients
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DOI：
10.1111/iwj.12146
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发表时间：
2015-10-01
影响因子：
3.1
通讯作者：
Boulton, Andrew J.
中科院分区：
文献类型：
--
作者：
Lavery, Lawrence A.;Lavery, David C.;Boulton, Andrew J.
糖尿病患者发生足部溃疡、截肢和住院的风险增加。我们评估了一组封闭的糖尿病患者，并确定了两个高风险组的危险因素：（i）透析患者和（ii）既往足部溃疡患者。我们使用来自 Scott and White Health Plan 的糖尿病 (ICD-9 250.X)、溃疡 (ICD-9 707.10、707.14 和 707.15) 和透析 (CPT 90935-90937) 的索赔数据来确定 150 名连续接受透析的糖尿病患者（透析组）和 150 名有足部溃疡病史的患者（溃疡病史组）。我们通过手动查看相应的电子病历来验证这些诊断。每位患者均获得 30 个月的随访期。透析患者和有溃疡病史的患者足部溃疡的发生率相同（每 1000 人年 210 例）。透析患者的截肢发生率较高（58.0 vs 13.3，P < 0.001）。两个研究组入院的情况都很常见。有溃疡病史组的住院发生率较高（477.3 vs 381.3，P < 0.001）；然而，在 30 个月的评估期间，透析组因足部相关入院的比例更高（32.9% 对比 14.0%，P < 0.001）。患有糖尿病、有足部溃疡病史或接受透析治疗的人，溃疡、截肢和全因住院的发生率很高；然而，接受透析治疗的患者因足部相关的住院率要高得多。减轻糖尿病足病负担的干预策略必须将透析患者作为高危人群。
Patients with diabetes have increased risk for foot ulcers, amputations and hospitalisations. We evaluated a closed cohort of patients with diabetes and established risk factors in two high risk groups: (i) dialysis patients and (ii) patients with previous foot ulceration. We used claims data for diabetes (ICD-9 250.X), ulceration (ICD-9 707.10, 707.14 and 707.15) and dialysis (CPT 90935-90937) from the Scott and White Health Plan to identify 150 consecutive patients with diabetes on dialysis (dialysis group) and 150 patients with a history of foot ulceration (ulcer history group). We verified these diagnoses by manually reviewing corresponding electronic medical records. Each patient was provided 30 months follow-up period. The incidence of foot ulcers was the same in dialysis patients and patients with an ulcer history (210 per 1000 person-years). The amputation incidence rate was higher in dialysis patients (58.0 versus 13.3, P < 0.001). Hospital admission was common in both study groups. The incidence of hospitalisation was higher in the ulcer history group (477.3 versus 381.3, P < 0.001); however, there were more foot-related hospital admissions in the dialysis group (32.9% versus 14.0%, P < 0.001) during the 30-month evaluation period. The incidence of ulcers, amputations and all-cause hospitalisations is high in persons with diabetes and a history of foot ulceration or on dialysis treatment; however, those on dialysis treatment have disproportionately higher rates of foot-related hospitalisations. Intervention strategies to reduce the burden of diabetic foot disease must target dialysis patients as a high-risk group.