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Borderie G, Foussard N, Larroumet A, Blanco L, Domenge F, Mohammedi K, Ducasse E, Caradu C, Rigalleau V. Albuminuric diabetic kidney disease predicts foot ulcers in type 2 diabetes. J Diabetes Complications 2023; 37:108403. [PMID: 36641879 DOI: 10.1016/j.jdiacomp.2023.108403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/24/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
Diabetic Foot Ulcers (DFU) are feared among individuals with diabetic kidney disease (DKD), but it is unclear whether they are more frequent, especially in normoalbuminuric DKD. Five hundred and twenty patients admitted in our diabetology ward from 2007 to 2017 were followed up during 54 ± 26 months. New DFUs were registered, and their relationship with the initial renal status was analyzed by LogRank and multivariate Cox regression analysis. The 520 subjects were mainly men (57.9 %), 62 ± 9 years old, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 % (72 ± 19 mmol/mol), and complications: 33.7 % macroangiopathies, 22.1 % previous foot ulcers, 44.8 % DKD, 26.9 % retinopathies. Fifty-seven new DFU occurred, mainly in subjects with DKD. DKD was related to later DFU (HR: 1.79; 95%CI: 1.05-3.07), this relationship stayed significant adjusted for age, gender, and a history of previous DFU (HR: 3.61; 95%CI: 2.11-6.18), and further adjusted for the duration of diabetes, HbA1c, BMI, arterial hypertension, and dyslipidemia. Among the 233 subjects with DKD, 129 (55.3 %) had an isolated AER > 30 mg/24H, 41 (17.6 %) had an isolated eGFR<60 mL/min/1.73 m2, and 63 (27.0 %) cumulated both abnormalities. By Cox regression analysis adjusted for age and gender, albuminuric DKDs were related to later DFU: with eGFR≥60: HR: 1.91; 95%CI: 1.02-3.59, with eGFR<60: HR: 2.53; 95%CI: 1.25-5.10, whereas normoalbuminuric DKD was not: HR: 1.04; 95%CI: 0.35-3.07, despite similar rates of neuropathies, peripheral arterial diseases, and retinopathies. In people with type 2 diabetes, albuminuric DKD was associated with two to three folds increased risk of DFUs, whereas normoalbuminuric DKD was not.
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Affiliation(s)
- Gauthier Borderie
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Ninon Foussard
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Alice Larroumet
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Laurence Blanco
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Frédéric Domenge
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Kamel Mohammedi
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Eric Ducasse
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Caroline Caradu
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France
| | - Vincent Rigalleau
- Bordeaux CHU and University, Endocrinology-Diabetology-Nutrition and Vascular Surgery, 33000 Bordeaux, France.
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Jansen RB, Holstein PE, Jørgensen B, Møller KK, Svendsen OL. Risk factors for development of nephropathy in patients with a diabetic Charcot foot. BMC Res Notes 2021; 14:403. [PMID: 34717731 PMCID: PMC8557477 DOI: 10.1186/s13104-021-05811-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/15/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Charcot foot is a rare complication to neuropathy and can cause severe foot deformities and ulcerations, which often require prolonged antibiotical treatment. The objective of this retrospective study was to investigate whether this treatment is associated to impaired renal function. Results In total, 163 patients were included, of whom 105 (64%) had received β-lactam antibiotics for a mean total duration of 13.0 months. There was a significant increase in the urine albumin/creatinine ratio in the group that received antibiotics (p = 0.017), and the use of antibiotics was associated to a subsequent diagnosis of nephropathy (p = 0.01). Patients treated with antibiotics had a 21.9% risk of developing subsequent nephropathy versus 5.2% for patients not treated with antibiotics. We suggest increased awareness on signs of nephropathy in patients with severe Charcot foot. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05811-5.
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Affiliation(s)
- Rasmus Bo Jansen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.
| | - Per E Holstein
- Copenhagen Wound Healing Center, CODIF, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
| | - Bo Jørgensen
- Copenhagen Wound Healing Center, CODIF, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
| | - Klaus Kirketerp Møller
- Copenhagen Wound Healing Center, CODIF, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
| | - Ole Lander Svendsen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.,Copenhagen Wound Healing Center, CODIF, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
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Caruso P, Longo M, Gicchino M, Scappaticcio L, Caputo M, Maiorino MI, Bellastella G, Esposito K. Long-term diabetic complications as predictors of foot ulcers healing failure: A retrospective study in a tertiary-care center. Diabetes Res Clin Pract 2020; 163:108147. [PMID: 32302666 DOI: 10.1016/j.diabres.2020.108147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/31/2020] [Accepted: 04/07/2020] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study was to investigate the factors involved in healing failure in a population of patients with diabetic foot ulcers (DFU) after one year of follow-up. METHODS One hundred and forty-four patients were treated for DFU in a tertiary-care center and had a regular follow-up for one year. Laboratory measurements and clinical assessments, including long-term diabetes complications and risk factors for DFU, were collected at baseline and patients were divided in two groups according to the outcome [Healed group (H, n = 91), and Not Healed group (NH, n = 53)]. RESULTS Compared with H group, NH group had significant higher levels of urinary albumin excretion [H vs NH, median (IQR), 23.5 (10.1, 41.1) vs 26.4 (20.8, 141.1), P = 0.032] and significantly increased prevalence of diabetic kidney disease (DKD) (22% vs 40%, P = 0.038) and Charcot Arthropathy (3% vs 16%, P = 0.025). No differences among the other long-term complications of diabetes, risk factors for DFU or clinical features were found. The multiple logistic regression analysis identified DKD and Charcot Arthropathy as negative predictors of healing. CONCLUSIONS In a population of people with type 2 diabetes with DFU treated in a tertiary-care center, DKD and Charcot Arthropathy were related to poor healing within one year-follow-up.
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Affiliation(s)
- Paola Caruso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy; Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Miriam Longo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy; Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Maurizio Gicchino
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Lorenzo Scappaticcio
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy; Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Mariangela Caputo
- Unit of Diabetes, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy; Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Giuseppe Bellastella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy; Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy; Unit of Diabetes, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, 80138 Naples, Italy.
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Sun J, Feng X, Zhu Q, Lin W, Guo H, Ansong E, Liu L. Analgesic effect of perineural magnesium sulphate for sciatic nerve block for diabetic toe amputation: A randomized trial. PLoS One 2017; 12:e0176589. [PMID: 28464014 PMCID: PMC5413065 DOI: 10.1371/journal.pone.0176589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 04/12/2017] [Indexed: 01/19/2023] Open
Abstract
Background and objectives High concentrations of local anesthetics may be neurotoxic for diabetic patients. Additive perineural administration of magnesium was reported to decrease the consumption of local anesthetics for nerve block. It was hypothesized that MgSO4 added to dilute ropivacaine was equianalgesic to more concentrated ropivacaine for toe amputations in diabetic patients. Methods Seventy diabetic patients were allocated into 3 groups: 1) perineural 200 mg MgSO4 added to 0.25% ropivacaine, 2) 0.25% ropivacaine alone, and 3) 0.375% ropivacaine alone. All patients underwent popliteal sciatic nerve block that was guided by ultrasonography using the respective regimens. Time of onset, duration of motor and sensory block were recorded. Spontaneous and evoked pain score, worst pain score, additional analgesic consumption, satisfaction score and initial time of analgesic requirement of each patient were documented up to 48 hours postoperatively. Results In comparison with 0.25% ropivacaine alone, magnesium supplement prolonged the duration of sensory block (p = 0.001), as well as better evoked pain score at 6 hour postoperatively (p = 0.001). In comparison with evoked pain score (1.6/10) in group of 0.375% ropivacaine, magnesium plus 0.25% ropivacaine presented a little higher score (2.5/10) at 6 hour postoperatively (p = 0.001), while lower worst pain score (p = 0.001) and less postoperative total analgesic consumption (p = 0.002). Conclusions The regimen of adding 200mg MgSO4 to 0.25% ropivacaine for sciatic nerve block yields equal analgesic effect in comparison with 0.375% ropivacaine. These findings have suggested that supplemental MgSO4 could not improve analgesic quality except reducing the total amount of local anesthetics requirement in diabetic toe amputations with sciatic nerve blocks.
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Affiliation(s)
- Jiehao Sun
- Department of Anesthesiology, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xiaona Feng
- Department of Anesthesiology, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qihan Zhu
- Department of Endocrinology, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wendong Lin
- Department of Anesthesiology, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hailei Guo
- Department of Burn, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Emmanuel Ansong
- Department of Anesthesiology, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
| | - Le Liu
- Department of Anesthesiology, 1 Affiliated Hospital, Wenzhou Medical University, Wenzhou, China
- * E-mail:
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Prevalence of Diabetic Foot Disease in Patients with Diabetes Mellitus under Renal Replacement Therapy in Lleida, Spain. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7217586. [PMID: 27190996 PMCID: PMC4848423 DOI: 10.1155/2016/7217586] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/30/2016] [Accepted: 03/31/2016] [Indexed: 12/13/2022]
Abstract
Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.
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Chammas NK, Hill RLR, Edmonds ME. Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type. J Diabetes Res 2016; 2016:2879809. [PMID: 27213157 PMCID: PMC4860228 DOI: 10.1155/2016/2879809] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/30/2016] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
Abstract
Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003-9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk.
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Affiliation(s)
- N. K. Chammas
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London SE5 9RS, UK
| | - R. L. R. Hill
- Department of Medical Microbiology, King's College School of Medicine, King's Denmark Hill Campus, Bessemer Road, London SE5 9PJ, UK
| | - M. E. Edmonds
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London SE5 9RS, UK
- *M. E. Edmonds:
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Yotsu RR, Pham NM, Oe M, Nagase T, Sanada H, Hara H, Fukuda S, Fujitani J, Yamamoto-Honda R, Kajio H, Noda M, Tamaki T. Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: neuropathic, ischemic, and neuro-ischemic type. J Diabetes Complications 2014; 28:528-35. [PMID: 24846054 DOI: 10.1016/j.jdiacomp.2014.03.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 03/07/2014] [Accepted: 03/24/2014] [Indexed: 02/07/2023]
Abstract
AIMS To identify differences in the characteristics of patients with diabetic foot ulcers (DFUs) according to their etiological classification and to compare their healing time. METHODS Over a 4.5-year period, 73 patients with DFUs were recruited. DFUs were etiologically classified as being of neuropathic, ischemic, or neuro-ischemic origin. Descriptive analyses were performed to characterize study subjects, foot-related factors, and healing outcome and time. Duration of healing was assessed using the Kaplan-Meier method. Healing time among the three types was compared using the log rank test. RESULTS The number of patients manifesting neuropathic, ischemic, and neuro-ischemic ulcers was 30, 20, and 14, respectively. Differences were identified for age, diabetes duration, body mass index, hypertension, and estimated glomerular filtration rate. Patients with neuro-ischemic ulcers had better ankle-brachial index, skin perfusion pressure (SPP), and transcutaneous oxygen pressure values compared to those with ischemic ulcers. The average time in which 50% of patients had healed wounds was 70, 113, and 233 days for neuropathic, neuro-ischemic, and ischemic ulcers, respectively. Main factors associated with healing were age and SPP values. CONCLUSIONS Based on the etiological ulcer type, DFU healing course and several patient factors differed. Failure to consider the differences in DFU etiology may have led to heterogeneity of results in previous studies on DFUs.
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Affiliation(s)
- Rie Roselyne Yotsu
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Ngoc Minh Pham
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Makoto Oe
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takeshi Nagase
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hisao Hara
- Division of Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shoji Fukuda
- Department of Cardiovascular Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junko Fujitani
- Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ritsuko Yamamoto-Honda
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kajio
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mitsuhiko Noda
- Department of Diabetes and Metabolic Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Tamaki
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
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Aragón-Sánchez J, Lázaro-Martínez JL, García-Álvarez Y, Morales EG, Hernández-Herrero MJ. Albuminuria is a predictive factor of in-hospital mortality in patients with diabetes admitted for foot disease. Diabetes Res Clin Pract 2014; 104:e23-5. [PMID: 24530117 DOI: 10.1016/j.diabres.2014.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 07/22/2013] [Accepted: 01/02/2014] [Indexed: 01/15/2023]
Abstract
Albuminuria has been previously reported as a risk factor for mortality in people with diabetes. In a retrospective series of 455 patients with diabetes and foot ulcers, albuminuria was a predictive factor of in-hospital mortality. Other predictive factors were: white blood cell count>12.9×10(9)/L, haemoglobin<108g/L and age >75 years old.
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Al-Thani H, El-Menyar A, Koshy V, Hussein A, Sharaf A, Asim M, Sadek A. Implications of foot ulceration in hemodialysis patients: a 5-year observational study. J Diabetes Res 2014; 2014:945075. [PMID: 24724108 PMCID: PMC3958654 DOI: 10.1155/2014/945075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
Foot ulceration (FU) remains a serious concern for patients worldwide. We analyzed the incidence, risk factors, and outcome of FU in hemodialysis (HD) patients. A retrospective cohort study was conducted for 252 HD patients who were followed up for 5 years. Patients were categorized according to whether they developed FU or not. The FU group (17%) was older and had significantly higher incidence of nephropathy, retinopathy, peripheral (PAD), coronary artery disease (CAD), and diabetes mellitus (DM) as compared to no-FU group. FU group had higher frequency of major amputation (P = 0.001) and HD vascular access (P = 0.01). Patients with combined DM and PAD had a 10-fold increased risk of FU in comparison to those who had DM alone. Presence of PAD was the main independent predictor for development of FU in HD with an adjusted odd ratio (aOR) of 16.0 (95% CI: 4.41-62.18; P = 0.001). After adjusting for age, sex, and CAD, predictors for mortality were PAD (aOR 4.3), FU (aOR 3.6), and DM (aOR 2.6). FU is common in HD patients regardless of DM. However, the presence of PAD is significantly associated with more FU and mortality in HD. HD patients need intensive foot care and warrant progressive modification of vascular risk factors.
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Affiliation(s)
- Hassan Al-Thani
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, P.O. Box 24144, Doha, Qatar ; Cardiology Section, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Valsa Koshy
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Ahmed Hussein
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Ahmed Sharaf
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Ahmed Sadek
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
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Ramanujam CL, Han D, Fowler S, Kilpadi K, Zgonis T. Impact of diabetes and comorbidities on split-thickness skin grafts for foot wounds. J Am Podiatr Med Assoc 2014; 103:223-32. [PMID: 23697729 DOI: 10.7547/1030223] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Split-thickness skin grafts can be used for foot wound closure in diabetic and nondiabetic patients. It is unknown whether this procedure is reliable for all diabetic patients, with or without comorbidities of diabetes, including cardiovascular disease, neuropathy, retinopathy, and nephropathy. METHODS We retrospectively reviewed 203 patients who underwent this procedure to determine significant differences in healing time, postoperative infection, and need for revisional surgery and to create a predictive model to identify diabetic patients who are likely to have a successful outcome. RESULTS Overall, compared with nondiabetic patients, diabetic patients experienced a significantly higher risk of delayed healing time and postoperative complication/infection and, hence, are more likely to require revisional surgery after undergoing the initial split-thickness skin graft procedure. These differences seemed to be related more to the presence of comorbidities than to diabetic status itself. Diabetic patients with preexisting comorbidities experienced a significantly increased risk of delayed healing time and postoperative infection and a higher need for revisional surgery compared with nondiabetic patients or diabetic patients without comorbidities. However, there were no significant differences in outcome between diabetic patients without comorbidities and nondiabetic patients. CONCLUSIONS For individuals with diabetes but without exclusionary comorbidities, split-thickness skin grafting may be considered an effective surgical alternative to other prolonged treatment options currently used in this patient population.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
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Monteiro-Soares M, Boyko EJ, Ribeiro J, Ribeiro I, Dinis-Ribeiro M. Predictive factors for diabetic foot ulceration: a systematic review. Diabetes Metab Res Rev 2012; 28:574-600. [PMID: 22730196 DOI: 10.1002/dmrr.2319] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Improving ability to predict and prevent diabetic foot ulceration is imperative because of the high personal and financial costs of this complication. We therefore conducted a systematic review in order to identify all studies of factors associated with DFU and assess whether available DFU risk stratification systems incorporate those factors of highest potential value. We performed a search in PubMed for studies published through April 2011 that analysed the association between independent variables and DFU. Articles were selected by two investigators-independently and blind to each other. Divergences were solved by a third investigator. A total of 71 studies were included that evaluated the association between diabetic foot ulceration and more than 100 independent variables. The variables most frequently assessed were age, gender, diabetes duration, BMI, HbA(1c) and neuropathy. Diabetic foot ulceration prevalence varied greatly among studies. The majority of the identified variables were assessed by only two or fewer studies. Diabetic neuropathy, peripheral vascular disease, foot deformity and previous diabetic foot ulceration or lower extremity amputation - which are the most common variables included in risk stratification systems - were consistently associated with diabetic foot ulceration development. Existing diabetic foot ulceration risk stratification systems often include variables shown repeatedly in the literature to be strongly predictive of this outcome. Improvement of these risk classification systems though is impaired because of deficiencies noted, including a great lack of standardization in outcome definition and variable selection and measurement.
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Affiliation(s)
- M Monteiro-Soares
- Endocrinology, Diabetes and Metabolism Department-Diabetic Foot Team, Centro Hospitalar de Vila Nova de Gaia/Espinho EPE, Portugal.
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Zubair M, Malik A, Ahmad J. The impact of creatinine clearance on the outcome of diabetic foot ulcers in north Indian tertiary care hospital. Diabetes Metab Syndr 2011; 5:120-125. [PMID: 22813563 DOI: 10.1016/j.dsx.2012.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Wound healing has been reported to be poor in diabetic patients with impaired kidney functions that usually accompanies retinopathy and neuropathy. The insensitive foot is vulnerable to repeated trauma and development of ulcer precedes 70-80% of non-traumatic lower extremity amputation. The present study was aimed to study the impact of creatinine clearance (CCre) on the outcome of diabetic foot ulcers (DFU). MATERIALS AND METHODS Data from 162 DFU patients admitted to Rajiv Gandhi Centre for Diabetes and Endocrinology of J.N. Medical College, Aligarh Muslim University, Aligarh, India, between December 2009 and March 2011 were analyzed. Detailed history and patient's profile, grade of DFU, co-morbidities and complications, laboratory data, microbiological profile and final outcome were collected. CCre was calculated according to MDRD formula. RESULTS The study revealed that, DFU healing was worst in patients with decreased CCre than in those who had normal CCre. Other factors associated with poor outcome were, higher grade of ulcer, infection type (subcutaneous and osteomyelitis) and biofilm infection. Amputation rates were also found to be higher in those with poor renal functions. CONCLUSIONS The results suggest that CCre is an important factor affecting wound healing in patients with DFUs. The automatic reporting of eGFR each time a serum creatinine concentration is requested will increase the awareness of significant kidney dysfunction in clinical practice especially in DFU patients and appropriate measures will improve the outcome.
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Affiliation(s)
- Mohammad Zubair
- Department of Microbiology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh 202002, India
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Akinci B, Yesil S, Bayraktar F, Kucukyavas Y, Yener S, Comlekci A, Eraslan S. The effect of creatinine clearance on the short-term outcome of neuropathic diabetic foot ulcers. Prim Care Diabetes 2010; 4:181-185. [PMID: 20471934 DOI: 10.1016/j.pcd.2010.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/18/2010] [Accepted: 04/09/2010] [Indexed: 11/17/2022]
Abstract
Reduced creatinine clearance is related to an increased risk for diabetic foot ulcer development. Wound healing has been reported to be worse in diabetic patients with impaired kidney functions than general diabetic population. This study aimed to investigate the effect of creatinine clearance on the short-term outcome of neuropathic diabetic foot ulcers. Data from 147 neuropathic diabetic foot ulcer episodes were included in this observational study. Patients were admitted to Dokuz Eylul University Hospital between January 2003 and June 2008. Patients were excluded if they had limb ischemia. Diabetic nephropathy was investigated by 24h urinary albumin excretion and serum creatinine levels. Creatinine clearance was calculated according to Cockcroft-Gault formula. Foot ulcers were followed up for 6 months to determine the outcome. Our short-term follow-up revealed that neuropathic diabetic ulcers healed worse in patients with decreased creatinine clearance than in those who had normal creatinine clearance. Amputation rates were also found to be higher. Our results suggest that creatinine clearance is an important factor affecting wound healing in patients with neuropathic diabetic foot ulcers.
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Affiliation(s)
- Baris Akinci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University, Turkey.
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Ndip A, Rutter MK, Vileikyte L, Vardhan A, Asari A, Jameel M, Tahir HA, Lavery LA, Boulton AJM. Dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and stage 4 or 5 chronic kidney disease. Diabetes Care 2010; 33:1811-6. [PMID: 20484126 PMCID: PMC2909067 DOI: 10.2337/dc10-0255] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and renal impairment. RESEARCH DESIGN AND METHODS We performed a cross-sectional study of consecutive patients with diabetes and stage 4 or 5 chronic kidney disease (CKD) attending clinics in Manchester (U.K.). Patients were classified as either receiving dialysis therapy (dialysis) or not (no dialysis). Foot assessment included diabetic peripheral neuropathy (DPN), peripheral arterial disease (PAD), prior foot ulceration and amputation, and foot self-care. Risk factors for prevalent foot ulceration were assessed by logistic regression. RESULTS We studied 326 patients with diabetes and CKD (mean age 64 years; 61% male; 78% type 2 diabetes; 11% prevalent foot ulceration). Compared with no dialysis patients, dialysis patients had a higher prevalence of DPN (79 vs. 65%), PAD (64 vs. 43%), prior amputations (15 vs. 6.4%), prior foot ulceration (32 vs. 20%), and prevalent foot ulceration (21 vs. 5%, all P < 0.05). In univariate analyses, foot ulceration was related to wearing bespoke footwear (odds ratio 5.6 [95% CI 2.5-13]) dialysis treatment (5.1 [2.3-11]), prior foot ulceration (4.8 [2.3-9.8], PAD (2.8 [1.3-6.0], and years of diabetes (1.0 [1.0-1.1], all P < 0.01). In multivariate logistic regression, only dialysis treatment (4.2 [1.7-10], P = 0.002) and prior foot ulceration (3.1 [1.3-7.1], P = 0.008) were associated with prevalent foot ulceration. CONCLUSIONS Dialysis treatment was independently associated with foot ulceration. Guidelines should highlight dialysis as an important risk factor for foot ulceration requiring intensive foot care.
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Affiliation(s)
- Agbor Ndip
- Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester National Institute Health Research Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, U.K
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Ndip A, Lavery LA, Boulton AJM. Diabetic foot disease in people with advanced nephropathy and those on renal dialysis. Curr Diab Rep 2010; 10:283-90. [PMID: 20532700 DOI: 10.1007/s11892-010-0128-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Among the spectrum of risk for diabetic foot disease conferred by chronic kidney disease (CKD), end-stage renal disease (ESRD) has emerged as a novel independent risk factor. Apart from the classical triad of neuropathy, infection, and peripheral arterial disease that operate in these individuals, the risk is further compounded by inadequate foot self-care by patients and by dialysis centers not providing onsite foot care, as medical priorities are diverted to the dialysis itself. Consequently, the burden of diabetic foot disease has increased in the CKD and ESRD population as exemplified by high ulceration, amputation, and foot-related mortality rates. Current guidelines on foot care in diabetes should recognize advanced CKD and ESRD/dialysis as a separate risk factor for foot disease to alert professionals and highlight the opportunity for prevention. Recent studies have demonstrated improved foot outcomes when chiropody programs are instituted within dialysis units.
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Affiliation(s)
- Agbor Ndip
- Diabetes Centre (Department of Medicine), Manchester Royal Infirmary, 193 Hathersage Road, Manchester, M13 0JE, UK.
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Rocco A, Heerlein K, Diedler J, Sykora M, Barrows R, Hacke W, Steiner T. Microalbuminuria in Cerebrovascular Disease: A Modifiable Risk Factor? Int J Stroke 2010; 5:30-4. [DOI: 10.1111/j.1747-4949.2009.00398.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stroke is potentially preventable through risk factor modification. Over the past decade, there has been considerable interest on microalbuminuria as a risk factor for chronic diseases. The concept of microalbuminuria was originally introduced, about 25 years ago, to clinical practice as a useful marker of nephropathy. Since then various studies reported an association of microalbuminuria with the increased risk of cardiovascular events and all cause of mortality in subjects with or without diabetes. The presence of microalbuminuria was related to left ventricular dysfunction, stroke, and myocardial infarction. Microalbuminuria may be a predictor of stroke but further studies are required. However data on prognostic significance and therapeutic consequence, particularly in haemorrhagic stroke are lacking. This review focuses on the importance of microalbuminuria for cerebrovascular disease, stressing the clinical and therapeutic implications using antihypertensive therapy to control the urinary albumin excretion.
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Affiliation(s)
- A. Rocco
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - K. Heerlein
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - J. Diedler
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - M. Sykora
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - R. Barrows
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - W. Hacke
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Th. Steiner
- Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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Papanas N, Liakopoulos V, Maltezos E, Stefanidis I. The diabetic foot in end stage renal disease. Ren Fail 2007; 29:519-28. [PMID: 17654312 DOI: 10.1080/08860220701391662] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Diabetic foot lesions remain a major cause of morbidity in patients with renal failure, especially those on dialysis. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The causal pathways of the diabetic foot in renal failure are multiple and inter-related. Three major pathologies--neuropathy, ischemia, and infection--are the main contributory factors. Increased awareness of this condition and careful clinical examination are indispensable to avoid serious complications. Appropriate management needs to address all contributory factors. Treatment options include revascularization, off-loading to relieve high-pressure areas, and aggressive control of infection. Equally important is the collaboration between health care providers in a multidisciplinary foot care setting. Moreover, patient education on the measures required to achieve both primary and secondary prevention is of great value. Certainly, technical innovations have made considerable progress possible, but there is a need for further improvement to reduce the number of amputations.
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Affiliation(s)
- N Papanas
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Greece
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Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJM. Evidence-Based Protocol for Diabetic Foot Ulcers. Plast Reconstr Surg 2006; 117:193S-209S; discussion 210S-211S. [PMID: 16799388 DOI: 10.1097/01.prs.0000225459.93750.29] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetic foot ulcers are the single biggest risk factor for nontraumatic foot amputations in persons with diabetes. Foot ulcers occur in 12 to 25 percent of persons with diabetes and precede 84 percent of all nontraumatic amputations in this growing population. Because of the high incidence of foot ulcers, amputations remain a source of morbidity and mortality in persons with diabetes. Strict adherence to evidence-based protocols as described herein will prevent the majority of these amputations. METHODS The collective experience of treating patients with neuropathic diabetic foot ulcers in four major diabetic foot programs in the United States and Europe was analyzed. RESULTS The following protocol was developed for patients with diabetic foot ulcers: (1) establishment of good communication among the patient, the wound healing team, and the primary medical doctor; (2) comprehensive, protocol-driven care of the entire patient, including hemoglobin A1c, microalbuminuria, and cholesterol as well as early treatment of retinopathy, nephropathy, and cardiac disease; (3) weekly objective measurement of the wound with digital photography, planimetry, and documentation of the wound-healing process using the Wound Electronic Medical Record, if available; (4) objective evaluation of blood flow in the lower extremities (e.g., noninvasive flow studies); (5) débridement of hyperkeratotic, infected, and nonviable tissue; (6) use of systemic antibiotics for deep infection, drainage, and cellulitis; (7) off-loading; (8) maintenance of a moist wound bed; (9) use of growth factor and/or cellular therapy if the wound is not healing after 3 weeks with this protocol; and (10) consideration of the use of vacuum-assisted therapy in complex wounds. CONCLUSIONS In diabetic foot ulcers, availability of the above modalities, in combination with early recognition and comprehensive treatment, ensures rapid healing, minimizes morbidity and mortality rates, and eliminates toe and limb amputations in the absence of ischemia and osteomyelitis.
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Affiliation(s)
- Harold Brem
- Department of Surgery, Wound Healing Program, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Rodríguez-Morán M, Guerrero-Romero F. Low serum magnesium levels and foot ulcers in subjects with type 2 diabetes. Arch Med Res 2001; 32:300-3. [PMID: 11440788 DOI: 10.1016/s0188-4409(01)00298-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hypomagnesemia is associated with the development of neuropathy and abnormal platelet activity, both of which are risk factors for the progression of ulcers of the feet. Thus, the aim of this study was to determine the relationship between low serum magnesium and foot ulcer in subjects with type 2 diabetes. METHODS Thirty-three out-patients with type 2 diabetes and foot ulcers (16 women and 17 men) were compared with a control group of 66 out-patients with type 2 diabetes without foot ulcers (35 women and 31 men), matched by age, diabetes duration, HbA1c, and glycemia. Patients with foot ulcers were included in the study only if a foot ulceration onset not exceeding 2 months was established. Patients diagnosed with reduced renal function, a history of alcohol intake, or as having received magnesium supplementation or diuretics were not included. Serum magnesium was measured by colorimetric method. The relationship between serum magnesium and foot ulcers was assessed by logistic regression. RESULTS Hypomagnesemia was identified in 31 (93.9%) subjects with foot ulcers, and 49 (73.1%) control subjects, p = 0.02. Subjects with foot ulceration had lower serum magnesium levels (1.48 +/- 0.33) than those in the control group (1.68 +/- 0.32), p <0.001. Logistic regression analysis showed a significant relationship between low serum magnesium levels and foot ulcers (odds ratio [OR] 2.9, CI 95% 1.7-6.8; p = 0.01). CONCLUSIONS Serum magnesium depletion is present and shows a strong relationship with foot ulcers in subjects with type 2 diabetes and foot ulcers, a relationship not previously reported.
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Affiliation(s)
- M Rodríguez-Morán
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital General, Instituto Mexicano del Seguro Social (IMSS), Durango, Mexico.
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Rodríguez-Morán M, Guerrero-Romero F. Hyperinsulinemia and abdominal obesity are more prevalent in non-diabetic subjects with family history of type 2 diabetes. Arch Med Res 2000; 31:399-403. [PMID: 11068083 DOI: 10.1016/s0188-4409(00)00089-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was undertaken in order to identify the relationships between family history of type 2 diabetes and cardiovascular risk factors in non-diabetic Mexican individuals. METHODS The design was a cross-sectional, population-based study stratified by age and sex. Participants consisted of 189 non-diabetic volunteers 30-64 years of age, both males and non-pregnant females randomly selected from a middle income neighborhood in Durango, Mexico and distributed into two groups, with and without family history of type 2 diabetes mellitus. Hypertensive subjects were excluded. Body mass index (BMI) and waist-to-hip ratio (WHR) were assessed. Hematocrit, both fasting and 2-h post 75-g glucose load insulin, and glucose levels, lipid profile, serum albumin, and proteinuria were measured. RESULTS Ninety-four (49.7%) individuals with family history of type 2 diabetes, and 95 (50.3%) in the control group were included. The prevalence of obesity was greater among women with family history of diabetes, 39 (73.6%) vs. 27 (50.0%) of the control group, p = 0.02. Adiposity tended to be centrally distributed in 86 subjects, of whom 22 (25. 6%) males and 54 (62.8%) females were in the group with family history of diabetes and four (4.6%) males and six (7.0%) females in the control group, p <0.000. Multivariate logistic regression analysis showed a strong relationship between family history of type 2 diabetes with both abdominal obesity (odds ratio [OR] 4.2, CI 95% 1.9-10.1, p <0.05) and fasting hyperinsulinemia (OR 3.1, CI 95% 1. 4-11.2, p <0.05). CONCLUSION In the absence of additional risk factors such as diabetes and hypertension, there is a strong relationship between family history of diabetes with hyperinsulinemia and abdominal obesity in middle-aged Mexican individuals.
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Affiliation(s)
- M Rodríguez-Morán
- Unidad de Investigación Médica, Hospital General, Instituto Mexicano del Seguro Social (IMSS), Durango, Durango, Mexico.
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Guerrero-Romero F, Rodríguez-Morán M. Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus. Stroke 1999; 30:1787-91. [PMID: 10471424 DOI: 10.1161/01.str.30.9.1787] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Proteinuria is an independent risk factor for cardiovascular disease in patients with NIDDM. The aim of this study was to assess the relationship between proteinuria and ischemic stroke in subjects with NIDDM, and to determine whether proteinuria is an independent risk factor for stroke. METHODS We performed a case-control study of 59 diabetic patients with first-ever ischemic stroke due to thrombotic arterial occlusion, who were considered cases, and 180 diabetic patients without stroke, matched by gender, age, and diabetes duration, as a control group. WHO criteria for verified definite or possible stroke were used to ascertain the diagnosis of stroke. For the purpose of this study proteinuria was defined as a 24-hour urinary protein excretion rate of >/=20 and <200 microg/min. Risk factors included were smoking, blood pressure, body mass index, serum total cholesterol, hyperglycemia, and proteinuria. RESULTS Subjects with stroke had higher proteinuria proportion and systolic and diastolic blood pressures. Both frequency of antihypertensive treatment and antihypertensive drugs used were similar among subjects with and without stroke. In multivariate logistic regression analysis, the ORs and 95% CIs for the variables identified as risk factors for stroke were as follows: systolic pressure (OR 3.10; 95% CI 3.01 to 4.21; P=0.03); diastolic pressure (OR 3.30; 95% CI 1.04 to 4.48; P<0.0001); fasting glucose >/=11.1 mmol (OR 1.82; 905% CI 1.4 to 3.8; P=0.04), HbA1c >/=9.5% (OR 1.7; 95% CI 1.3 to 5.1; P<0.01), and proteinuria (OR 3.23; 95% CI 1.06 to 4.36; P<0.0001). CONCLUSIONS Our case-control study gives evidence that proteinuria is an independent risk factor for ischemic stroke in patients with NIDDM.
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Affiliation(s)
- F Guerrero-Romero
- Medical Research Unit in Clinical Epidemiology and the Research Group on Diabetes and Chronic Illnesses, General Hospital of the Mexican Social Security Institute, Durango, Mexico.
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