| [ Summary ] |
Peripheral artery disease (PAD) is observed in 15 to 20 % of hemodialysis patients. The risk of lower limb amputation is reportedly 10-times higher in this group as compared to the general population. Diabetes mellitus now accounts for more than half of the primary factors leading to a need for hemodialysis therapy. This situation strongly affects the development of PAD and its prognosis. In our cohort study after initiation of hemodialysis therapy, 10-year event-free rates for development of PAD and lower limb amputation where significantly lower in the diabetes patients than in non-diabetes patients (60.3 % vs. 82.8 % and 93.9 % vs. 98.9 %, respectively). Hypoalbuminemia and elevated C-reactive protein levels were also identified as predictors. In patients with diabetes, quartile analysis of HbA1c levels showed that the highest quartile group had significant development of PAD and lower limb amputation compared to lower quartile groups (33.1 % vs. 9.9 % and 6.1 % vs. 0.9 %, respectively). This data suggests the importance of detection of disease in the early stages of PAD and well controlled glycemic levels for hemodialysis patients with diabetes. Furthermore, daily foot care is also clinically important for both primary and secondly prevention for PAD due to the co-morbid conditions such as chronic inflammation or malnutrition in this population. |