Podiatric Care Lowers Diabetic-Foot Amputation Risk in Dialysis Population – Renal and Urology News

Patients with kidney failure at risk for diabetic foot ulcers (DFUs) who receive foot and ankle care from podiatrists may be at lower risk for diabetes-related amputations compared with those who receive care from other specialists, according to investigators.

The finding is from a study of 14,935 Medicare patients receiving dialysis who had new diagnoses of DFUs during calendar years 2016 to 2019. The exposure of interest was foot and ankle care provided by a podiatrist within 3 months prior to study baseline (ie, the index DFU diagnosis). Of these patients, 2736 (18.4%) received care by podiatrists in the 3 months before the index diagnosis. The index date was the first DFU diagnosis in 2017.

Over a mean 13.5 months of follow-up, 70% of patients who received prior podiatric care experienced death and/or major amputation compared with 74% of those who did not. In adjusted analyses, podiatric care was significantly associated with an 11% lower risk for death and/or amputation and 9% lower risk for major amputation above or below the knee, Tze-Woei Tan, MBBS, MPH, of the Keck School of Medicine at the University of Southern California in Los Angeles, and colleagues reported in JAMA Network Open.

The survival probabilities were 26.3% vs 22.8% at 36 months for the podiatric and nonpodiatric groups, respectively.

“In this comprehensive analysis of a national cohort comprising Medicare beneficiaries with kidney failure and DFUs, the receipt of foot and ankle care provided by podiatrists within the 3 months preceding a DFU diagnosis was associated with reduction in the risks of major amputation and death among patients with kidney failure who were receiving dialysis,” Dr Tan’s group concluded.

The investigators identified study patients using US Renal Data System claims data. They focused on Medicare beneficiaries to ensure adequate claims history. The study population had a mean age of 59.3 years. The racial/ethnic composition was 58.5% White, 35% Black, 17.7% Hispanic, and 2.7% Asian.