Preventing amputations in patients with diabetes and renal disease

Diabetes remains the single most common cause of both end stage renal disease and non-traumatic amputation of the lower limb. The available literature confirms a close association between renal disease, peripheral symmetrical neuropathy, peripheral vascular disease, foot ulcers, amputation and survival in patients with diabetes, and suggests that the risk accelerates soon after the start of renal replacement therapy. There are multiple possible mechanisms underlying the association, including the effects of dialysis on tissue hypoxia. At present there are no specific interventions known to improve these pathogenic mechanisms; however, there is evidence to suggest that the organisation of care could have an impact on the onset of foot disease. These patients therefore should have regular foot surveillance, education, and support from appropriate specialists to manage their foot care. All professionals involved in the care of patients with diabetes and renal disease should be aware of the extent to which the patient's feet are at risk. Copyright (C) 2012 John Wiley & Sons.