Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review

Sarah M Manewell; Purnima Rao; Keren Haneman; Minjia Zheng; Hady Charaf; Hylton B Menz; Cathie Sherrington; Serene S Paul

doi:10.1186/s13047-023-00679-z

Prevention and management of foot and lower limb health complications in adults undergoing dialysis: a scoping review

J Foot Ankle Res. 2023 Nov 20;16(1):81. doi: 10.1186/s13047-023-00679-z.

Authors

Sarah M Manewell^{1

2}, Purnima Rao³, Keren Haneman³, Minjia Zheng⁴, Hady Charaf⁵, Hylton B Menz⁶, Cathie Sherrington⁷, Serene S Paul⁸

Affiliations

¹ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia. sman0630@uni.sydney.edu.au.
² Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia. sman0630@uni.sydney.edu.au.
³ Podiatry Department, Sydney Local Health District, NSW Health, Camperdown, Australia.
⁴ School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia.
⁵ Faculty of Podiatric Medicine, School of Health Sciences, Western Sydney University, NSW, Campbelltown, Australia.
⁶ School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.
⁷ Institute for Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney/Sydney Local Health District, NSW, Camperdown, Australia.
⁸ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, NSW, Camperdown, Australia.

Abstract

Background: Foot and lower limb health complications are common among patients undergoing dialysis; but a summary of prevention and management evidence is not available. The aim of this scoping review was to summarise study characteristics and the nature of results regarding strategies to prevent and manage peripheral arterial disease (PAD), foot ulceration, amputation, associated infection and associated hospital admission in adults undergoing dialysis.

Methods: MEDLINE, Embase, CINAHL and AMED databases were searched for longitudinal experimental and observational studies. Eligible studies included adults undergoing dialysis (≥10 dialysis patients, with separate results or ≥ 75% of the cohort). Any interventions relating to PAD, foot ulceration, amputation, associated infection, and associated hospital admission were included.

Results: The review included 212 studies, of which 199 were observational (94%) and 13 were experimental (6%). Sixteen studies (8%) addressed the prevention of foot and lower limb health complications, 43 (20%) addressed management, and 153 (72%) addressed both. The main intervention type in each study was surgery (n = 159, 75%), care from one or more health professionals (n = 13, 6%), screening by a health professional (n = 10, 5%), medication (n = 9, 4%) and rehabilitation (n = 5, 2%). No studies were identified where exercise, offloading or education were the main intervention. Results for PAD were reported in 137 (65%) studies, foot ulceration in 54 (25%), amputation in 171 (81%), infection in 7 (3%), and admission in 26 studies (12%). Results for more than one foot or lower limb outcome were reported in 141 studies (67%), with each study reporting on average two outcomes. Results varied and spanned positive, negative, and neutral outcomes following intervention.

Conclusions: Identified studies frequently aimed to both prevent and manage foot and lower limb health complications. A variety of interventions were identified and studies often reported results for more than one foot or lower limb health outcome. Findings from this review can be used to guide future research, with a goal to support improved patient outcomes.

Keywords: Dialysis; End stage renal disease; Foot; Lower limb.

Publication types

Review

MeSH terms

Adult
Amputation, Surgical
Foot Ulcer* / etiology
Humans
Lower Extremity
Peripheral Arterial Disease* / etiology
Peripheral Arterial Disease* / prevention & control
Renal Dialysis / adverse effects
Risk Factors