Losing a leg is one of the most traumatic consequences of advanced kidney disease, but the risk of amputations has dropped significantly since 2000, a new study finds.
Between 2000 and 2014, amputations among U.S. patients with end-stage kidney disease who were receiving dialysis were cut by 51 percent. Despite the decrease, however, almost half of patients who had amputations died within a year of losing a leg, Stanford University researchers report.
“Although it is good news that patients with end-stage renal disease receiving dialysis have had a decrease in amputation rates over the past several years, the rates are still much higher than what has been reported in patients with more normal kidney function — a fact that is probably evident to anyone who has ever spent time in a dialysis unit,” said senior investigator Dr. Tara Chang. She is director of clinical research in the division of nephrology at Stanford.
Patients with kidney disease have a higher risk for losing a leg because they have an increased risk for peripheral artery disease, which occurs when there’s not enough blood reaching the legs, Chang explained.
“We do not know exactly why patients with kidney disease are at higher risk,” she said. “It could be related to other diseases, like diabetes or high blood pressure, which are more common in patients with kidneydisease.”
In addition, some unique risk factors for amputation in patients with kidney disease, such as inflammation, vascular calcification or uremia, also play a role, Chang added.
The reason amputation rates are dropping isn’t clear, but it might reflect better overall care, she said.
“It may be related to better blood sugar, blood pressure and cholesterol management, more frequent foot checks, or other interventions,” Chang said.
Still, “clearly more needs to be done for these patients,” she added.
For the study, the research team collected data on nearly 800,000 women and men with end-stage kidney disease undergoing dialysis from 2000 through 2014.
Over the study period, amputations decreased 51 percent. The decrease was mostly seen in the rate of major amputations, the researchers found.
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