The value of Doppler waveform analysis in predicting major lower extremity amputation among dialysis patients treated for diabetic foot ulcers

• Published in: Diabetes research and clinical practice 2013-05, Vol.100 (2), p.181-188
• Main Authors: Tsai, Chih-Yiu, Chu, Sung-Yu, Wen, Yu-Wen, Hsu, Lung-An, Chen, Chun-Chi, Peng, Shih-Hui, Huang, Chung-Huei, Sun, Jui-Hung, Huang, Yu-Yao
• Format: Article
• Language: English
• Subjects: Aged; Amputation - statistics & numerical data; Diabetic Foot - surgery; Diabetic foot ulcer; Dialysis; Doppler waveform analysis; Endocrinology & Metabolism; Female; Humans; Lower Extremity - surgery; Lower extremity amputation; Male; Middle Aged; Peripheral arterial disease; Peripheral Arterial Disease - surgery; Retrospective Studies; Risk Factors
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2013.03.017

Abstract Aims This study examined the predictors for lower extremity amputation (LEA) in patients with diabetic foot ulcers according to kidney function and, in the case of dialysis patients, specifically evaluated the vasculature with the ankle–brachial index (ABI) and Doppler waveforms. Methods Among 658 diabetic patients admitted to the Diabetic Foot Care Center, 286 had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min per 1.73 m2 , 275 had an eGFR < 60, and 97 patients were under maintenance dialysis. All clinical variables were analyzed. A specialist retrospectively reviewed Doppler images of 78 of the patients in dialysis to evaluate peripheral arterial disease. Results Forty-two percent of patients with eGFR < 60 presented with ABI ≤ 0.90. For ABI values > 1.40, the proportion of dialysis patients (31.3%) was greater than the proportion of patients with eGFR < 60 (5.3%). Wagner wound classifications, reduced serum albumin levels, and low ABI values were the predictors for major LEA among patients in the non-dialysis groups. Nevertheless, these indicators were not predictive of the risk of amputation in diabetic patients on dialysis. The presence of poor monophasic waveforms in the dorsalis pedis artery or posterior tibial artery served as an independent predictor (odds ratio: 7.61; P = 0.008) for major LEA among dialysis patients. The sensitivity and specificity were 88.0% and 59.6%, respectively. Conclusions Poor monophasic Doppler waveforms of below-the-knee arteries, commonly found among dialysis patients in treatment for diabetic foot ulcers, can serve as an independent predictor for major LEA.