Background: Although risk factors for diabetic foot ulceration (DFU) have been extensively studied in patients with diabetes in Egypt, there is surprisingly limited evidence among those on chronic hemodialysis (CHD).
Aims: To investigate the risk factors for foot ulceration in adult patients with diabetes with end stage renal disease on hemodialysis in Dakahlia Governorate central hemodialysis units.
Patients and methods: This Cross-sectional study included all diabetic patients under CHD aged ≥ 18 years (n = 98), recruited over 7 months from the largest seven central hemodialysis units in Dakahlia governorate, Egypt. Dakahlia governorate has 18 central hemodialysis units. Data were collected on the following variables: age; gender; type and duration of DM; duration of dialysis, previous history of foot ulcers/ amputation, previous foot care education, and previous use of therapeutic footwear or custom made insoles (CMI). The feet were thoroughly examined, according to the International Working Group on the Diabetic Foot 2019 recommendations, to identify any deformities, skin or nail pathology, tenia pedis, or DFU. Footwear and foot health care behaviors were also assessed. Peripheral sensory neuropathy was detected using the 10-g (5.07 Semmes- Weinstein) monofilament. Peripheral arterial status was assessed by palpating the dorsalis pedis and posterior tibial pulses on both feet. The diagnosis of peripheral arterial disease (PAD) was further confirmed by measuring ankle pressure (Duplex; Bidop ES-100 V3 Hadeco Inc, Japan) and calculation of ankle-brachial index.
Results: The study included 57 males and 41 females. The mean age was 57.94 ± 8.93 years. The median duration of diabetes was 15 (2–33) years. 61 (62.2%) patients were on insulin therapy. The median duration of hemodialysis was 3 years. Insensate neuropathy was diagnosed in 65.3% of patients, and 15.3% of patients had PAD. The prevalence of foot deformities was 18.36%. Dry skin and plantar calluses were recorded in 62.2% and 27.6% of patients, respectively. Tinea pedis was found in 45.9%. 2 (2.04%) patients had active foot ulcers, 9 (9.18%) patients had ulcers in remission; therefore the overall DFU prevalence was 11.22%. Ten patients (10.2%) had previous minor amputations, with no reported major amputations. 95.92% of patients had poor foot health care behaviors, and 81.63% were using inappropriate footwear. None of the included patients previously used CMI.
Conclusions: The key finding of this article suggests a high prevalence of risk factors for foot ulceration among diabetic patients receiving hemodialysis. Diabetic foot screening should be included in management strategy of those on CHD.
23 May 2020 - 26 Feb 2020