ArticleClinical kidney journal2020
Mortality after amputation in dialysis patients is high but not modified by diabetes status.
Article in Clinical kidney journal, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 7 citations in OpenAlex.
- Incidence and Risk Factors of Stump Complications Following Amputation in Patients With Diabetes: A Retrospective Analysis of the Nationwide Inpatient Sample.World journal of surgery · 2026Article
- Lower limb amputation in incident dialysis patients in England: incidence, outcomes and inter-centre variation from a national registry study.Clinical kidney journal · 2026Article
- Predictors of 30-day mortality in major lower limb amputations: insights from a five-year retrospective study in a South Asian LMIC.BMC surgery · 2025Article
- A tool to predict the risk of lower extremity amputation in patients starting dialysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2024Article
- Health Education Programmes to Improve Foot Self-Care Knowledge and Behaviour among Older People with End-Stage Kidney Disease (ESKD) Receiving Haemodialysis (A Systematic Review).Healthcare (Basel, Switzerland) · 2022Review
- The unaccomplished mission of reducing mortality in patients on kidney replacement therapy.Clinical kidney journal · 2020Article
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSurvival 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.
methodsData 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).
resultsDuring 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).
conclusionsAmputation 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.
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