Friday, March 27, 2009

Preventive Foot Care In Hemodilaysis Patients

Diabetics on hemodialysis have even worse prognosis than other patients. Patients with diabetes and ESRD are admitted to the hospital on average 2.3 times per year, and only 27% of these patients will survive 5 years on hemodialysis. With improvement in overall care, mortality has improved in hemodialysis patient population, but perhaps not to the expected level for multiple reasons. One likely explanation is that although mortality may be less with improvement in one area of care, mortality in other neglected areas of care may negate these potential gains. It therefore remains imperative that nephrology community does not lose sight of the fact that only comprehensive care of these patients will realize the goal of improvement in mortality and morbidity in this hemodialysis population. One such area of care which remains under the radar is morbidity and mortality related to peripheral vascular disease and foot care. For the most part, at this stage, foot care attracts attention only after a problem has already arisen. There are no screening protocols in hemodialysis centers to identify the problem earlier on. As a result preventive strategies to reduce morbidity and mortality related to this issue remains unaddressed. The magnitude of this problem is unrealized until you add to the equation that majority of hemodilaysis patients are diabetics as well. As a result there remains a significant issue of lower extremity amputations in hemodialysis patients.

by Zahid Ahmad, M.D.

University of Oklahoma

Asst. Professor of Medicine – Interventional Nephrology

Section of Nephrology & Hypertention

Monday, March 23, 2009


  • 67% of amputations are done as the initial treatment
  • Only 50% get a thorough foot screening (ABI)before their amputation
  • 75% of major lower extremity amputations are the cause of critical ischemia, the main consequence for renal failure patients
  • Estimated 85% of amputation are preventable
  • 40% + mortality rate within 12-18 months of a amputation

Monday, March 16, 2009

Foot Screenings


  • Preventive foot care to diabetic patients can lower amputation rates
  • Estimated that less than 10% of ESRD patients receive monthly foot screens
  • Less than half of the US dialysis centers have a program in place for routine screenings
  • Severe forms of Peripheral Artery Disease (PAD) manifest in the form of Lower Limb Ischemia
  • Estimated less than 5% of ESRD patients with early PAD are referred to a specialist for further diagnosis and treatment

Monday, March 9, 2009

Preventive Foot Care In Hemodilaysis Patients ...Can we continue to Ignore?

"Preventive foot care for hemodialysis patients is lost in efforts and time spent to provide care in other much politicized areas of care. But ignoring prevention in this area leads to significant morbidity and mortality. There are no randomized controlled trials of intensive education and care management versus usual care of feet in diabetic dialysis patients. Nonetheless, diabetic dialysis patients are likely to benefit from examination of the foot as part of the routine dialysis care. Given the fact that prevention can be easily done in hemodialsyis centre by hemodialysis nursing staff, there is little reason not to introduce it. Three times a week contact between hemodialysis nurses and patient is a potential opportunity to assess risks, educate and provide early intervention for foot issues in CKD population. Simple measures such as routine foot screening and education for this high risk population can prevent ulcer-initiating events and detect small ulcers when they may heal with proper intervention. Preventive strategies should include protocol based strategy for referral to specialist. Computerized network should allow this to happen seamlessly and effortlessly to the benefit all involved in hemodialysis care. In this regard, all involved in medical care of hemodialysis patients can no longer afford to ignore the importance of preventive care of hemodialysis patients."
~Dr. Zahid Ahmad, M.D.~