Poor prognosis after lower-limb amputation irrespective of diabetes status in patients undergoing hemodialysis

Ther Apher Dial. 2022 Nov 4. doi: 10.1111/1744-9987.13947. Online ahead of print.


Introduction: Diabetes mellitus is one of the most important risk factors for lower-limb amputation in patients undergoing hemodialysis. However, the influence of diabetes mellitus on survival after lower-limb amputation is unknown.

Methods: Patients who underwent lower-limb amputation since 1996 (amputation group) and those who underwent hemodialysis during 2011-2012 (control group) were included and were followed up until July 2022.

Results: There were 70 patients (age: 66.3 ± 8.2 years, 80% male, 77% diabetic) in the amputation group and 328 (age: 67.5 ± 13.5 years, 56% male, 33% diabetic) in the control group. The amputation group showed a poorer prognosis than the control group (hazard ratio [HR]: 2.41, p < 0.001). In the control group, patients with diabetes exhibited poorer survival than those without diabetes (HR: 1.86, p < 0.001). In the amputation group, patients with diabetes exhibited improved survival (HR: 0.47, p = 0.02).

Conclusion: Patients undergoing hemodialysis who underwent lower-limb amputation exhibited a poor prognosis, irrespective of diabetes status.

Keywords: diabetes mellitus; hemodialysis; lower-limb amputation; peripheral artery disease.