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Rates of lower extremity amputations due to end-stage renal disease decline

From 2000 to 2014, there was a 51% decrease in the rate of nontraumatic major and minor lower extremity amputations among patients with end-stage renal disease who receive dialysis, according to findings published in JAMA Internal Medicine.

“Patients with end-stage renal disease (ESRD) who receive dialysis are at high risk of lower extremity amputation,” Douglas Franz, MD, MPH, from Stanford University, and colleagues wrote. “Recent studies indicate decreasing rates of lower extremity amputation in non-ESRD populations, but contemporary data for patients with ESRD who receive dialysis are lacking.”

Franz and colleagues analyzed more than 3 million records from the United States national ESRD registry to determine the trends in the rates of lower extremity amputation among patients with ESRD who received dialysis from 2000 to 2014 and whether such trends differed by age, sex, diabetes or geographic region. They measured rates of both nontraumatic major amputations, defined as above- or below-knee, and minor amputations, defined as below-ankle.

In each annual cohort, patients were mainly men (52.5% in 2000, 53.8% in 2005, 55.1% in 2010, and 56% in 2014) and white (58.1% in 2000, 56.9% in 2005, 56.9% in 2010, and 56.7% in 2014).

The researchers found that over the course of the study period, there was a 51% decrease in the rate of lower extremity amputations for patients with ESRD who receive dialysis. They noted that this reduction was driven by 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).

Patients with diabetes were five times more likely to have an amputation than those without diabetes. Patients younger than 65 years and men were also more likely to have an amputation.

Adjusted analysis showed that there was a decrease in 1-year mortality rates after lower extremity amputation for patients with ESRD who receive dialysis from 2000 to 2013 (52.2% vs. 43.6%).

All geographic regions showed a reduction in amputation rates, although regional variability persisted even when adjusting for differences in patient demographics and comorbid conditions.

“Despite improvements, patients with end-stage renal disease who receive dialysis continue to display high rates of lower extremity amputation and postamputation 1-year mortality,” Franz and colleagues wrote.

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

Disclosure: Franz reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.