The effect of renal dysfunction on presentation and outcome of diabetic foot in Jabir Abu Eliz diabetic center, Khartoum

Abstract EN

Objective : Diabetes mellitus remains the single most common cause of end stage renal disease, blindness and non-traumatic amputation of the lower extremity.

Diabetic nephropathy is the leading cause of chronic renal failure worldwide.

This study aimed to report the effects of renal dysfunction on presentation and outcomes of diabetic foot.

Methods : This was a prospective case-control study done in Jabir Abu Eliz Diabetic Centre (JADC) in Khartoum during the period January 2013 till January 2014.

Two hundred diabetic patients were included, one hundred patients with foot ulcers (cases group) and the other one hundred without foot ulcers (controls group).

Patients were classified according to Cockcroft- Gault formula into six stages of chronic kidney disease (CKD), by estimate of plasma creatinine clearance (ml/minute).

Results: The mean age for the study group was 55.14±9.33 years and for the control group was 55.99±10.19, (p=0.539).

Males were predominantly affected in the study group in comparison to the control group.

The mean duration of diabetes in the study group was 14.30±9.28 years and for the control group it was 10.33±6.92 years, (p=0.001).

There were 84 patients in the study group with uncontrolled diabetes, and this was significantly higher than the 71 patients in the control group, (p=0.028).

68 patients in the study group had previous foot ulceration, while only 35 patients in the control group had similar history, (p=0.000).

Twelve patients in the study group had previous amputation in comparison to only 4 patients in the control group, (p=0.035).

Seventy patients in the ulcer group had significant peripheral neuropathy compared to 29 patients in the control group (p=0.000).

There were 35 patients in the study group who were diagnosed with different significant lower limb ischemia compared to 6 patients in the control group (p=0.04).

Three patients in the case group died during the follow-up period, while no patient died in the control group.

There were 40 patients in the ulcer group diagnosed with stage 3-5 renal failure, compared to 23 patients with the same stages in the control group, (p=0.010).

Patients with renal dysfunction had more amputation (major one) (p=0.028), delayed wound healing (p=0.030) and mortality rate (p=0.061).

Conclusions : Diabetic patients with foot ulceration had more renal dysfunction than the control group.

Late renal dysfunction was associated with more amputations, delayed wound healing and death.

Peripheral neuropathy and peripheral vascular disease were significantly more common in the ulcer group with renal dysfunction.