Study finds comorbid diabetes increases risk for lower extremity amputation with kidney disease

Patients with comorbid diabetes have an elevated risk for lower extremity amputation (LEA) at all stages of chronic kidney disease (CKD) compared with patients without diabetes, according to a study published online in the November issue of Journal of Diabetes and Its Complications.

Dhruv Nandakumar, from University of Texas Southwestern Medical School in Dallas, and colleagues evaluated the impact of diabetes on LEA rates in patients at various stages of CKD. The analysis included roughly 1.06 million patients with CKD and diabetes and 547,414 patients with CKD but no diabetes from 2010 to 2023.

The researchers found that rates of all LEA (overall, minor, and major LEA) were significantly higher at all CKD stages for patients with diabetes. For patients with diabetes and CKD stage 5, there was an increased likelihood of undergoing overall LEA (odds ratio [OR], 30.2), minor LEA (OR, 28.9), and major LEA (OR, 40.1) compared with patients without diabetes who had CKD stage 5.

Independent of diabetes status, minor LEAs were performed with greater frequency than major LEAs across all stages of CKD. LEA rates significantly increased with CKD progression between stages 2 and 5 with comorbid diabetes, with a substantial jump between stages 4 and 5 (OR, 2.6). There were no significant increases in LEA rates with CKD progression between stages 1 and 2 in patients with diabetes.

“Foot and ankle surgeons who treat diabetes-related foot conditions should recognize the clinical consequences of worsening renal function,” the authors write.

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