Temporal association between the incidence of foot ulceration and the start of dialysis in diabetes mellitus
Temporal association between the incidence of foot ulceration and the start of dialysis in diabetes mellitus
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DOI：
10.1093/ndt/gfl427
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发表时间：
2006-11-01
影响因子：
6.1
通讯作者：
Jeffcoate, William J.
中科院分区：
文献类型：
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作者：
Game, Frances L.;Chipchase, Susan Y.;Jeffcoate, William J.
背景本研究的目的是寻找肾脏替代治疗（RRT）的开始与首次记录的糖尿病足溃疡之间的时间关联。方法。从肾脏数据库中提取所有接受RRT的糖尿病患者的详细信息，并与足部专科诊所的数据库进行交叉检查。记录首次登记的足部溃疡发生日期，并与RRT发生日期进行比较。采用自身对照病例系列研究方法，建立RRT开始与首次记录的糖尿病足溃疡之间的任何显著时间相关性。自1976年以来，在我院接受透析的466例糖尿病患者中，有94例（20.2%）记录为至少有一处足部溃疡，其中15例接受了大截肢。计算了90例患者的发生率比（IR），这些患者的完整数据可用。在RRT开始和首次记录的足部溃疡之间观察到密切的时间相关性：相对于透析前时间，透析第1年和第2年与第5年之间的IR（95% CI）分别为3.35（95% CI：1.59-7.04）和4.56（2.19-9.50）。大截肢率第1年为31.98（2.09-490.3），第2 ~ 5年为34.01（1.74-666.2）。这些结果揭示了糖尿病RRT的发生与足部溃疡的发生之间的密切关系，并证实了透析患者截肢的高发生率。在RRT开始之前和之后，应采取紧急措施协调糖尿病足护理的各个方面。
Background. The aim of this study was to seek a temporal association between the start of renal replacement therapy (RRT) and the first recorded foot ulcer in diabetes.Methods. Details of all patients with diabetes who had received RRT were extracted from the renal database and were cross-checked with the database held in the specialist foot clinic. The date of onset of first registered foot ulcer was taken and compared with the date of onset of RRT. The self-controlled case-series method was used to establish any significant temporal association between the start of RRT and first recorded foot ulcer in diabetes.Results. Of 466 patients with diabetes dialysed at our hospital since 1976, 94 (20.2%) were recorded as having at least one foot ulcer, with 15 of these undergoing major amputation. Incidence ratios (IRs) were calculated for 90 patients in whom complete data were available. A close temporal association was observed between the start of RRT and the first recorded foot ulceration: IR (95% CI) in the first and between the second and fifth years of dialysis were 3.35 (95% CI: 1.59-7.04), and 4.56 (2.19-9.50), respectively, relative to the time before dialysis. The IR for major amputation was 31.98 (2.09-490.3) in the first year and 34.01 (1.74-666.2) in the second to fifth years.Conclusion. These results reveal a close relationship between the onset of RRT in diabetes and the onset of foot ulceration, and confirm the high incidence of amputation in those on dialysis. Urgent steps should be taken to coordinate all aspects of diabetes foot care before and after the start of RRT.