Factors associated with future amputation among patients undergoing hemodialysis: results from the Dialysis Morbidity and Mortality Study Waves 3 and 4

Am J Kidney Dis. 2003 Jan;41(1):162-70. doi: 10.1053/ajkd.2003.50000.


Background: Amputation is more common in hemodialysis patients than in the general population, but risk factors for amputation in this population have not been studied extensively.

Methods: We used the US Renal Data System Dialysis Morbidity and Mortality Study Waves 3 and 4 in combination with Medicare discharge data to identify factors associated with lower-extremity amputation (excluding toe amputations) in hemodialysis patients. We used stepwise multivariable logistic regression analysis to identify variables most strongly associated with amputation within 2 years of the study start date.

Results: Male sex, diabetes, previous diagnosis of peripheral vascular disease (PVD), mean systolic blood pressure, and elevated serum phosphorus level were associated with the outcome of amputation within 2 years of the study start date. Among patients without diabetes, a previous diagnosis of cardiac disease, longer time from initiation of dialysis therapy (vintage), and previous hospitalization for limb ischemia were associated with increased risk for future amputation.

Conclusion: The importance of preventing amputation in this population cannot be overemphasized. The strength of the association of amputation with PVD makes a strong case for screening all dialysis patients for this disease. The association of amputation with serum phosphorus level reported here should be explored further because this may offer an avenue for future intervention to reduce amputation rates.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Amputation* / trends
  • Blood Pressure
  • Cross-Sectional Studies
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / mortality
  • Diabetes Mellitus / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Leg / pathology
  • Leg / surgery
  • Logistic Models
  • Male
  • Middle Aged
  • Peripheral Vascular Diseases / blood
  • Peripheral Vascular Diseases / epidemiology
  • Peripheral Vascular Diseases / mortality
  • Peripheral Vascular Diseases / surgery
  • Phosphorus / blood
  • Renal Dialysis* / adverse effects
  • Renal Dialysis* / methods
  • Renal Dialysis* / mortality
  • Risk Factors
  • Systole
  • Treatment Outcome


  • Phosphorus