Poor prognosis after lower-limb amputation irrespective of diabetes status in patients undergoing hemodialysis
Akira Tamaki
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Search for more papers by this authorCorresponding Author
Mineaki Kitamura
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Correspondence
Mineaki Kitamura, Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Email: [email protected]
Search for more papers by this authorKosei Yamaguchi
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Search for more papers by this authorHideyuki Tomura
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Search for more papers by this authorTakahiro Takazono
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
Search for more papers by this authorHiroshi Mukae
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
Search for more papers by this authorTomoya Nishino
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Search for more papers by this authorAkira Tamaki
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Search for more papers by this authorCorresponding Author
Mineaki Kitamura
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Correspondence
Mineaki Kitamura, Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Email: [email protected]
Search for more papers by this authorKosei Yamaguchi
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Search for more papers by this authorHideyuki Tomura
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Nagasaki Renal Center, Nagasaki, Japan
Search for more papers by this authorTakahiro Takazono
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
Search for more papers by this authorHiroshi Mukae
Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
Search for more papers by this authorTomoya Nishino
Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
Search for more papers by this authorAbstract
Introduction
Diabetes mellitus is one of the most important risk factors for lower-limb amputation in patients undergoing hemodialysis. However, the influence of diabetes mellitus on survival after lower-limb amputation is unknown.
Methods
Patients who underwent lower-limb amputation since 1996 (amputation group) and those who underwent hemodialysis during 2011–2012 (control group) were included and were followed up until July 2022.
Results
There were 70 patients (age: 66.3 ± 8.2 years, 80% male, 77% diabetic) in the amputation group and 328 (age: 67.5 ± 13.5 years, 56% male, 33% diabetic) in the control group. The amputation group showed a poorer prognosis than the control group (hazard ratio [HR]: 2.41, p < 0.001). In the control group, patients with diabetes exhibited poorer survival than those without diabetes (HR: 1.86, p < 0.001). In the amputation group, patients with diabetes exhibited improved survival (HR: 0.47, p = 0.02).
Conclusion
Patients undergoing hemodialysis who underwent lower-limb amputation exhibited a poor prognosis, irrespective of diabetes status.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| tap13947-sup-0001-TableS1.docxWord 2007 document , 19.6 KB | Table S1. Summary of available glycemic control data before amputation |
| tap13947-sup-0002-FigureS1.jpgimage/jpp, 972.3 KB | Figure S1. Patient flow diagram of the study |
| tap13947-sup-0003-FigureS2.jpgimage/jpp, 822.6 KB | Figure S2. Histograms for hemoglobin A1c (national glycohemoglobin standardization program; HbA1c [NGSP]) or estimated HbA1c (NGSP) in patients with and without diabetes |
| tap13947-sup-0004-FigureS3A.jpgimage/jpp, 835.3 KB | Figure S3A. A summary of the causes of death. (A) Patients with diabetes who underwent lower-limb amputation |
| tap13947-sup-0005-FigureS3B.jpgimage/jpp, 822.4 KB | Figure S3B. Patients without diabetes who underwent lower-limb amputation |
| tap13947-sup-0006-FigureS4.jpgimage/jpp, 873.8 KB | Figure S4. Kaplan–Meier curves for patient survival. Survival was compared between the two groups using the log-rank test. Survival difference in patients undergoing lower-limb amputation with HbA1c level ≥7.0% or GA level ≥20% and those with HbA1c level <7.0% or GA level <20%. There was no significant difference between the two groups (p = 0.87) |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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