Nearly Half of Dialysis Patients With ESRD Die Within 1 Year of Amputation

Many dialysis patients with end-stage renal disease (ESRD) who undergo a lower extremity amputation die within a year after amputation, according to new research.

“Although rates of lower extremity amputations among US patients with ESRD who receive dialysis decreased by 51% during a recent 15-year period, mortality rates remained high, with nearly half of patients dying within a year after lower extremity amputation,” the researchers wrote.

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These findings arose from a study of 3,700,902 records of patients with ESRD who received dialysis. Patients were assessed in annual cohorts from 2000 and 2014. Data analysis was performed from August 2017 to April 2018.

The primary outcome was the annual rates of non-traumatic major (above or below the knee) and minor amputations (below the ankle) per 100 person-years.

In each annual cohort, there were fewer women than men, and more than half of patients were white. Results of the study demonstrated that rates of lower extremity amputations in this patient population decreased by 51.0% from 2000 to 2014, largely due a decline in the rate of major amputations (5.42 per 100 person-years in 2000 vs 2.66 per 100 person-years in 2014).

Amputations were 5 times more common in patients with diabetes vs those without diabetes. In addition, adjusted amputation rates were higher among men and patients younger than age 65 years and compared with women and patients older than 65 years.

Following adjustment, 1-year mortality rates following lower extremity amputation decreased from 2000 to 2013 (52.2% vs 43.6%), with amputation rates decreasing in all regions during this time period. However, the researchers noted that regional variability persisted over time, even after adjustment for various factors.

“Our results highlight the need for more research on ways to prevent lower extremity amputation in this extremely high-risk population,” they concluded.

—Christina Vogt

Reference:

Franz D, Zheng Y, Leeper NJ, et al. Trends in rates of lower extremity amputation among patients with end-stage renal disease who receive dialysis [Published online July 9, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.2436