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Mortality after amputation in dialysis patients is high but not modified by diabetes status

Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreas...

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Published in:Clinical Kidney Journal 2020-12, Vol.13 (6), p.1077-1082
Main Authors: Schroijen, Marielle A, van Diepen, Merel, Hamming, Jaap F, Dekker, Friedo W, Dekkers, Olaf M
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container_issue 6
container_start_page 1077
container_title Clinical Kidney Journal
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creator Schroijen, Marielle A
van Diepen, Merel
Hamming, Jaap F
Dekker, Friedo W
Dekkers, Olaf M
description Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.
doi_str_mv 10.1093/ckj/sfz116
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One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.</description><identifier>ISSN: 2048-8505</identifier><identifier>EISSN: 2048-8513</identifier><identifier>DOI: 10.1093/ckj/sfz116</identifier><identifier>PMID: 33391752</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Amputation ; Analysis ; Chronic kidney failure ; Comorbidity ; Diabetes ; Diabetics ; Medical research ; Medicine, Experimental ; Original ; Patient outcomes</subject><ispartof>Clinical Kidney Journal, 2020-12, Vol.13 (6), p.1077-1082</ispartof><rights>The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA. 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.</rights><rights>COPYRIGHT 2020 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-ba5aceb3cf2b7a7e775e482aa4f3dfac65769d89dde7d0007df6f802ab6d387e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769538/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769538/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33391752$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schroijen, Marielle A</creatorcontrib><creatorcontrib>van Diepen, Merel</creatorcontrib><creatorcontrib>Hamming, Jaap F</creatorcontrib><creatorcontrib>Dekker, Friedo W</creatorcontrib><creatorcontrib>Dekkers, Olaf M</creatorcontrib><title>Mortality after amputation in dialysis patients is high but not modified by diabetes status</title><title>Clinical Kidney Journal</title><addtitle>Clin Kidney J</addtitle><description>Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.</description><subject>Amputation</subject><subject>Analysis</subject><subject>Chronic kidney failure</subject><subject>Comorbidity</subject><subject>Diabetes</subject><subject>Diabetics</subject><subject>Medical research</subject><subject>Medicine, Experimental</subject><subject>Original</subject><subject>Patient outcomes</subject><issn>2048-8505</issn><issn>2048-8513</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><recordid>eNptkkFLHTEQx0OxVLFe-gFKoAi9PM1uNpvsRRCpVlC82FMPYTaZvBe7u1k3WeH56c3j2YeCySHD_H_zZ4YMId8KdlKwhp-afw-n0T0XRf2JHJSsUgslCr63i5nYJ0cxPrB8ssIq8YXsc86bQorygPy9DVOCzqc1BZdwotCPc4Lkw0D9QK2Hbh19pGNO4ZAizfHKL1e0nRMdQqJ9sN55tLRdb-gWE0Yas8Mcv5LPDrqIR6_vIflz-ev-4vfi5u7q-uL8ZmEqKdKiBQEGW25c2UqQKKXASpUAlePWgamFrBurGmtR2jyFtK52ipXQ1pYrifyQnG19x7nt0Zrc5wSdHiffw7TWAbx-rwx-pZfhSctsLLjKBj9fDabwOGNMuvfRYNfBgGGOusx9sqauqw36Y4suoUPtBxeyo9ng-lzKqlFKNUWmTj6g8rXYexMGdD7n3xV8fzvCrvf_H5WB4y0Q5nGnFkxvdkDnHdDbHeAvFOCkcA</recordid><startdate>20201201</startdate><enddate>20201201</enddate><creator>Schroijen, Marielle A</creator><creator>van Diepen, Merel</creator><creator>Hamming, Jaap F</creator><creator>Dekker, Friedo W</creator><creator>Dekkers, Olaf M</creator><general>Oxford University Press</general><scope>TOX</scope><scope>NPM</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20201201</creationdate><title>Mortality after amputation in dialysis patients is high but not modified by diabetes status</title><author>Schroijen, Marielle A ; van Diepen, Merel ; Hamming, Jaap F ; Dekker, Friedo W ; Dekkers, Olaf M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-ba5aceb3cf2b7a7e775e482aa4f3dfac65769d89dde7d0007df6f802ab6d387e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Amputation</topic><topic>Analysis</topic><topic>Chronic kidney failure</topic><topic>Comorbidity</topic><topic>Diabetes</topic><topic>Diabetics</topic><topic>Medical research</topic><topic>Medicine, Experimental</topic><topic>Original</topic><topic>Patient outcomes</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schroijen, Marielle A</creatorcontrib><creatorcontrib>van Diepen, Merel</creatorcontrib><creatorcontrib>Hamming, Jaap F</creatorcontrib><creatorcontrib>Dekker, Friedo W</creatorcontrib><creatorcontrib>Dekkers, Olaf M</creatorcontrib><collection>Open Access: Oxford University Press Open Journals</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical Kidney Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schroijen, Marielle A</au><au>van Diepen, Merel</au><au>Hamming, Jaap F</au><au>Dekker, Friedo W</au><au>Dekkers, Olaf M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Mortality after amputation in dialysis patients is high but not modified by diabetes status</atitle><jtitle>Clinical Kidney Journal</jtitle><addtitle>Clin Kidney J</addtitle><date>2020-12-01</date><risdate>2020</risdate><volume>13</volume><issue>6</issue><spage>1077</spage><epage>1082</epage><pages>1077-1082</pages><issn>2048-8505</issn><eissn>2048-8513</eissn><abstract>Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>33391752</pmid><doi>10.1093/ckj/sfz116</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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subjects Amputation
Analysis
Chronic kidney failure
Comorbidity
Diabetes
Diabetics
Medical research
Medicine, Experimental
Original
Patient outcomes
title Mortality after amputation in dialysis patients is high but not modified by diabetes status
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