Albuminuric diabetic kidney disease increases risk for foot ulcers
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Adults with type 2 diabetes have a higher risk for diabetic foot ulcers if they have albuminuric diabetic kidney disease, but not if they have normal albumin levels, according to study findings.
“In type 2 diabetes, previous cohort studies found a doubled risk for diabetic foot ulcers or amputations in subjects with diabetic kidney disease (DKD); however, they did not distinguish albuminuric from nonalbuminuric cases,” Vincent Rigalleau, MD, PhD, head of the diabetology unit, department of endocrinology and nutrition at Bordeaux University Hospital in France, told Healio. “For our 520 participants, the higher risk for diabetic foot ulcers only concerned subjects with albuminuric DKD.”
Rigalleau and colleagues analyzed data from 520 adults hospitalized at Bordeaux University Hospital from 2007 to 2017 for uncontrolled type 2 diabetes or type 2 diabetes complications. Blood and urinary samples were collected for all patients. The presence of albuminuric DKD at admission was defined as having an albumin excretion rate of more than 30 mg over 24 hours. Those with normoalbuminuric DKD had only an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2. Researchers examined health records for all participants to search for new cases of diabetic foot ulcers until December 2020.
The study was published in the Journal of Diabetes and Its Complications.
The study included 520 adults with type 2 diabetes (57.9% men; mean age, 62 years), of whom 44.8% had DKD at hospitalization. During a mean 54 months of follow-up, there were 57 cases of diabetic foot ulcers, with 34 occurring in adults with DKD and 23 in those without DKD. Adults with DKD had a higher risk for diabetic foot ulcers than those without DKD after adjusting for age, sex and history of previous foot ulcers (HR = 1.79; 95% CI, 1.05-3.07). The association remained significant after further adjustments for diabetes duration. Associations with HbA1c, BMI, arterial hypertension and statin use were not significant after further adjusting for the presence of neuropathy and peripheral arterial disease.
Of the 233 adults with DKD, 192 had albuminuric DKD, with 129 having only a high albumin excretion rate and 63 having both a high albumin excretion rate and a low eGFR. The remaining 41 participants had nonalbuminuric DKD with only a low eGFR. After adjusting for age and sex, adults with albuminuric DKD with only a high albumin excretion rate (HR = 1.91; 95% CI, 1.02-3.59) and those with a high albumin excretion rate and low eGFR (HR = 2.53; 95% CI, 1.25-5.1) had an increased risk for foot ulcers compared with those without DKD. However, adults with nonalbuminuric DKD did not have an increased risk for diabetic foot ulcers.
Rigalleau said providers should be concerned about the increased risk for diabetic foot ulcers among adults with albuminuric DKD, but the study revealed normoalbuminuric DKD may have a more benign process, though more research is needed.
“As only 41 of our patients had normoalbuminuric DKD, our study requires replications,” Rigalleau said. “Whether nephroprotective treatments may help to reduce the risk of diabetic foot ulcers is unknown.”
For more information:
Vincent Rigalleau, MD, PhD, can be reached at vincent.rigalleau@chu-bordeaux.fr.
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