Rates of Lower Extremity Amputation Decline in Dialysis Patients

By Megan Brooks

July 11, 2018

NEW YORK (Reuters Health) - Rates of lower extremity amputation declined over the past 15 years in Medicare patients with end-stage renal disease (ESRD) receiving dialysis, according to a new study.

"We as clinicians are doing somethings right, given the drop in amputation rates. It may be related to better blood sugar, blood pressure and cholesterol management, or more frequent foot checks, or other interventions," study investigator Dr. Tara Chang from Stanford University in California noted in email to Reuters Health.

Patients ESRD on dialysis are at high risk of lower extremity amputation. Recent studies suggest decreasing rates of lower extremity amputation in non-ESRD populations, but up-to-date data in patients with ESRD on dialysis are lacking, the investigators note in paper online July 9 in JAMA Internal Medicine.

Their assessment of more than 3.7 million records in the US national ESRD registry found that the adjusted rate of lower extremity amputations fell 51% between 2000 to 2014, from 5.42 per 100 person-years in 2000 to 2.66 in 2014.

The adjusted rate of above-knee and below-knee amputations decreased by 65% and 59%, respectively, while the adjusted rate of below-ankle amputations decreased by 26%.

Patients with comorbid diabetes also saw a decline in amputation rates, but their rates remained more than five times higher than rates in patients without diabetes. The adjusted amputation rate for diabetes patients fell by 53% from 8.65 per 100 person-years in 2000 to 4.09 in 2014; for patients without diabetes, the rate decreased by 48% from 1.43 per 100 person-years to 0.74.

Amputation rates fell in nearly all regions of the country but remained higher in the South and Northeast than in the West and Midwest. Amputation rates were also higher in patients younger than 65 and in men.

Following lower extremity amputation, adjusted one-year mortality rates decreased from 52% in 2000 to 44% in 2013, but remain high, the researchers note.

"Clearly more still needs to be done for patients with ESRD receiving dialysis, which will require more research focused specifically on this high-risk population," Dr. Chang told Reuters Health.

The study had no commercial funding. Dr. Chang has received consulting fees from Janssen, Novo Nordisk and Fresenius Medical unrelated to this work.

SOURCE: http://bit.ly/2N0T5DG

JAMA Intern Med 2018.

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