Renal failure and foot ulcer or lower extremity amputation in those patients with diabetes

NewsBot · Oct 12, 2024

Lower extremity amputation rates in patients with chronic kidney disease: A database study comparing patients with and without diabetes mellitus
Dhruv Nandakumar et al
J Diabetes Complications. 2024 Sep 28;38(11

Lower extremity amputation (LEA) is one of the most feared consequences of diabetes mellitus (DM). The purpose of this study was to evaluate the impact of DM on LEA rates in patients at various stages of chronic kidney disease (CKD). A commercially available de-identified database was searched for patients undergoing LEA and for CKD patients, from 2010 to 2023. Patients with DM and patients without DM who were followed for at least 5 years were included. LEA rates were then compared for patients at all 5 CKD stages in patients with and without diabetes. Rates of all LEA were found to be significantly higher at all CKD stages for patients with diabetes (overall, minor and major LEA). Compared to patients without DM who have CKD stage 5 (end stage renal disease), patients with DM and CKD stage 5 have a 30 fold increased likelihood of undergoing overall LEA [OR 30.2 (24.48-37.19), p < 0.001], 29 fold increased likelihood of undergoing minor LEA [28.9i (22.91-36.35), p < 0.001] and 40 times fold increased likelihood of undergoing major LEA [40.1 (26.59-60.42), p < 0.001]. For all stages of CKD, independent of diabetes status, minor LEA were performed with greater frequency than major LEA. In patients with DM, LEA rates significantly increased with CKD progression between stages 2-5 with a substantial jump between stages 4 and 5 [OR 2.6 (CI 2.49-2.74), p < 0.001]. However, CKD progression between stages 1 and 2 was not significantly associated with increased LEA rates (OR 1.1 (CI 0.92-1.21), p = 0.24) in patients with diabetes. Patients with comorbid diabetes have elevated risk for LEA at all stages of CKD compared to those without diabetes.
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NewsBot · Nov 4, 2024

Increased risk of renal events in people with diabetic foot disease: A longitudinal observational study
Fadi Alkhami et al
Source

Abstract
Objective
Diabetic kidney disease favors diabetic foot ulcers, however we do not know whether the reverse relation exists. We investigated whether diabetic foot disease (DFD) related to an increased risk of developing renal events.
Research design and methods
We conducted a retrospective analysis of a cohort of patients hospitalized for type 2 diabetes mellitus (T2DM) between 2009 and 2017, stratified for the risk of diabetic foot ulcer grades 0 (no risk), 1 and 2 (at risk), and 3 (DFD) according to the International Work Group on Diabetic Foot (IWGDF) classification. We highlighted new renal events (end-stage renal disease or a doubling of serum creatinine) in their medical records until December 2020. The relationship between DFD and later renal events was analyzed by multivariable Cox regression model.
Results
Among 519 patients, 142 (27 %) had a DFD at baseline, and 159 (30 %) were classified as Grades 1 or 2. Thirty-six renal events occurred during the 54 ± 27 months of follow-up: 19 subjects started dialysis, 1 had a renal transplantation, and 16 had a doubling of serum creatinine: 15 each in subjects with DFD and subjects at risk, versus 6 in subjects with Grade 0 DFD (logrank: P = 0.001). Adjusted for i) age and sex; ii) hyperglycemic exposure; iii) conventional cardiovascular risk factors; iv) renal parameters: and v) new diabetic foot ulcers during follow-up, DFD (HR 2.7 to 5.9) and being at risk of DFD Grades 1–2 (HR 2.8 to 5.1) were significantly related to new renal events.
Conclusion
The risk of renal events was increased in people with T2DM and DFD.
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NewsBot · Nov 7, 2024

Use of toe systolic blood pressures and toe brachial pressure indices in people receiving dialysis: A scoping review
Rachel Carle et al
J Ren Care. 2024 Nov 6

Introduction: Current guidelines for noninvasive lower limb vascular testing specify a preference for toe brachial pressure measurement to aid in the diagnosis of peripheral arterial disease populations with high suspicion of peripheral vessel calcification, such as those with kidney failure with replacement therapy.

Objectives: The aim was to identify the current literature on toe systolic blood pressure and toe brachial pressure index for individuals with kidney failure who are receiving replacement therapy.

Design: A scoping review.

Methods: MEDLINE, CINAHL, AMED and SPORTDiscus were systematically searched between July 15 and July 30, 2023. The scoping review followed the Arksey and O'Malley framework, with data reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews.

Results: Sixteen studies were included in the review. There was limited data examining the significance of toe systolic blood pressure and toe brachial pressure index during a dialysis session. There were differences in the normative values for toe brachial pressure index values used in the studies and limited reporting on the measurement protocols used to determine toe systolic blood pressure and toe brachial pressure index.

Conclusion: The review found limited data examining the clinical utility of toe systolic blood pressure and toe brachial pressure index in populations receiving dialysis. The use of toe systolic blood pressure and toe-brachial index to identify peripheral artery disease in this population is important. However, there is limited evidence and conflicting information on measurement protocols, reliability, diagnostic accuracy, and prognostic capacity.
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NewsBot · Dec 31, 2024

Chronic Kidney Disease and Charcot Neuro-Osteoarthropathy of Foot in Diabetes
Jayaditya Ghosh et al
Source

Introduction
Charcot neuro-osteoarthropathy (CNO) occurs late in diabetes and may cause fracture, deformity, and higher mortality. Diabetic kidney disease (DKD) affects bone metabolism and contributes to mortality. However, there is no data on prevalence of CNO and its outcomes with coexisting DKD (or chronic kidney disease [CKD]).
Methods
To ascertain the prevalence of CKD (pick CKD or DKD) among patients with CNO and delineate the remission of active CNO and subsequent lower extremity amputation and all-cause mortality during prospective follow-up. Consecutive patients with diabetic CNO (active or inactive) were enrolled and subsequently divided into those with and without CKD (pick CKD or DKD) (Group A and Group B, respectively). A preestablished timeframe of 36 weeks was utilized to evaluate the remission proportion of active CNO.
Results
A total of 493 CNO patients were observed and 449 subjects (150 patients had active CNO) were further evaluated. The overall prevalence of diabetic nephropathy (DKD or CKD?) CNO was 43.7%. The proportion of patients achieving remission was significantly lower in Group A compared to Group B (OR 0.468, CI [0.239-0.934], P = .025), however, the median time for achieving remission was similar between the 2 groups (14 weeks vs 16 weeks, P = .885). Overall, all-cause mortality was notably higher Group A compared to Group B (OR 2.23, 95% CI [1.474-3.368]) over a median follow-up of 4 years. No significant differences were observed in rates of diabetic foot ulcers (58.2% vs 54.9%; P = .584) and amputations (17.4% vs 15.12%; P = .889) between Group A and Group B.
Conclusion
Patients of CNO with coexisting CKD have poor prognosis both in terms of likelihood of active CNO remission and higher mortality.
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NewsBot · Jan 5, 2025

Exploring Chronic Pain in Hemodialysis Patients: An Observational Study Based on the New IASP Classification for ICD-11
Vittorio Schweiger, Martina Cacciapuoti, Marta Nizzero, Salvatore Simari, Gianmarco Lombardi, Leonardo Gottin, Lisa Stefani, Alvise Martini, Giustino Varrassi, Gabriele Finco, Enrico Polati & Giovanni Gambaro
Pain and Therapy

Introduction

Pain is one of the most frequently reported symptoms in hemodialyzed (HD) patients, with prevalence rates between 33% and 82%. Risk factors for chronic pain in HD patients are older age, long-lasting dialysis history, several concomitant diseases, malnutrition, and others. However, chronic pain assessment in HD patients is rarely performed by specialists in pain medicine, with relevant consequences in terms of diagnostic and treatment accuracy. Furthermore, no study has used the recently introduced International Association for the Study of Pain (IASP) pathophysiological classification.
Methods

In this observational, cross-sectional study in a tertiary HD center in Northern Italy, we analyzed data regarding HD patients, evaluated for 5 months in 2021 by specialists in pain medicine and aimed to identify and characterize chronic pain according to the IASP definition and the last 2019 classification of chronic pain for ICD-11. Pain severity was evaluated by the pain severity score of the brief pain inventory tool.
Results

Among 213 patients, 65 (31%) suffered from chronic pain. The average age was 73.1 years; 55.5% of the patients were male; 53.7% had diabetes, and 39.2% had arterial hypertension. Of the 54 patients subjected to an in-depth evaluation, data regarding 113 pain diagnoses were extracted, particularly related to osteoarthritis, obliterating arterial disease, and low back pain with or without radiculopathy. On the basis of these diagnoses, the pain classification according to the IASP pathophysiological definition highlighted a predominant nociceptive pain type (53.9% of all the diagnoses), followed by neuropathic (22.1%), mixed (22.1%), nociplastic (2.6%), and idiopathic (2.6%) pain. According to the IASP classification for ICD-11, the clinical diagnosis of chronic pain secondary to obliterating arterial disease and diabetes-related foot ulcers could not be assigned to any diagnostic category as a result of the lack of a specific item in the aforementioned classification.
Conclusion

This study confirmed that chronic pain is a common, burdening issue in hemodialysis patients and that it is of a prevalent nociceptive nature. Our study highlights some limitations of the last IASP ICD-11 classification, especially the lack of specific items for some pain features that are very frequent in hemodialysis patients, and not only in that population. Finally, this study underlines the importance of mutual collaboration between pain physicians and nephrologists for the well-being of patients of high clinical complexity, such as those undergoing chronic hemodialysis.
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NewsBot · May 24, 2025

Chronic Kidney Disease as an Independent Risk Factor for Chronic Lower Extremity Ulcers: A Cross-Sectional Analysis of US Adults
Hai Gao et al
Int J Low Extrem Wounds. 2025 May 22

BackgroundChronic lower extremity ulcers (CLEU) are a significant health burden, often linked to complications such as diabetes and vascular diseases. Chronic kidney disease (CKD), a prevalent global health issue, has been increasingly associated with CLEU, though the nature of this relationship remains poorly understood. This study aimed to explore the association between CKD and CLEU in the US adult population.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. The study included adults aged 20 years and older who completed interviews and examinations. CLEU was defined as self-reported ulcers or sores on the leg or foot lasting more than four weeks. CKD was diagnosed based on the 2012 KDIGO guidelines, using estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Logistic regression models were used to assess the association between CKD and CLEU, adjusting for demographics, BMI, lifestyle factors, and comorbidities.ResultsAmong 8564 participants, individuals with CKD had a higher likelihood of developing CLEU, with an unadjusted odds ratio (OR) of 2.33 (95% CI: 1.86-2.91). After adjusting for confounders, the association remained significant, with adjusted ORs of 1.64 (95% CI: 1.26-2.12) and 1.57 (95% CI: 1.2-2.04) in Models 2 and 3, respectively. Stratified analyses showed no significant interactions across subgroups defined by age, sex, diabetes, hypertension, hyperlipidemia, and peripheral artery disease (PAD).ConclusionThis study demonstrates a robust association between CKD and CLEU in US adults, suggesting that CKD is an independent risk factor for CLEU. These findings highlight the need for integrated management strategies for CKD patients to reduce the risk of CLEU. Future longitudinal studies are needed to establish causality and inform targeted interventions.
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NewsBot · May 29, 2025

Correlation between chronic kidney disease and all-cause mortality in diabetic foot ulcers: evidence from the 1999-2004 national health and nutrition examination survey (NHANES)
Jiaru Liang et al
Front Endocrinol (Lausanne). 2025 Mar 14:16:1533087

Background: The poor prognosis of diabetic foot ulcers (DFUs) often leads to amputation and high mortality rates, becoming a heavy economic burden on the healthcare system. Several clinical studies have been conducted to investigate the risk factors for DFU mortality and to provide clinical guidance for better prevention and control of DFU mortality.

Methods: We used R to organize the mortality data of patients with DFU, collected from the NHANES database during the 1994-2004 period, along with three kidney function indicators including Albumin-to-Creatinine Ratio (ACR), estimated Glomerular Filtration Rate (eGFR) and cystatin C, used to assess chronic kidney disease (CKD). We explored the relationship between CKD and the risk of death in DFU patients through multiple kidney function indicators. Baseline characteristics of the surviving group and the mortality group of patients with DFU were analyzed using the 'svyby' function in the 'survey' package. We used Kaplan-Meier curves, multivariable logistic regression models, Cox proportional risk regression models, and time-dependent ROC curves to analyze the relationship between CKD and the risk of death in patients with DFU.

Results: This study included a total of 112 patients with DFU. The overall sample had an average age of 65 years, with 43 females (38.39%) and 69 males (61.61%). During the follow-up time, 29 survived and 89 died. All-cause mortality in DFU patients was analyzed based on clinical classifications of ACR, eGFR, and cystatin C, with Kaplan-Meier curves illustrating survival variability. Multivariable logistic regression analysis showed no significant correlation between the risk of death in patients with DFU and CKD. However, analysis of Cox proportional risk regression model that accounted for time effects found a significant association between all-cause mortality and cystatin C levels in patients with DFU. Time-dependent ROC curve analysis demonstrated that cystatin C had superior diagnostic accuracy and stability for predicting all-cause mortality in DFU patients.

Conclusions: In this study, we found that cystatin C demonstrated greater stability and accuracy in assessing the risk of death and predicting mortality in patients with DFU.+
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NewsBot · Jun 5, 2025

The dialysis foot- the impact of presenting estimated glomerular filtration rate on clinical outcomes in patients hospitalized with diabetic foot infections
Arthur Tarricone et al
Int Wound J. 2025 May;22(5):e70122

To evaluate the association between presenting estimated glomerular filtration rate (eGFR) and clinical outcomes in patients hospitalized with diabetic foot infections. This retrospective cohort study included 344 patients with moderate to severe diabetic foot infections. Patients were categorized into three groups based on presenting estimated eGFR: eGFR ≥60 (eGFR >60 mL/min), eGFR 30-60 (eGFR 30-60 mL/min) and eGFR <30 (eGFR <30 mL/min). Outcomes assessed included wound healing, time to heal, re-infection, amputation, mortality and re-hospitalization for infection. Compared with patients with eGFR <30, patients with eGFR ≥60 had significantly lower rates of retinopathy, peripheral arterial disease and use of beta blockers or calcium channel blockers. Glycated haemoglobin levels were inversely related to eGFR, decreasing as eGFR severity increased. Haemoglobin levels were significantly lower, and inflammatory markers (ESR and CRP) were significantly higher in patients with eGFR <30. There were no significant differences among eGFR groups in rates of wound healing, time to heal, re-infection or amputation. However, mortality increased with decreasing eGFR (1.9% in eGFR ≥60 vs. 3.2% in eGFR 30-60 vs. 8.1% in eGFR <30; p = 0.04). Similarly, re-hospitalization for infection at a different site also increased with decreasing eGFR (20.5% in eGFR ≥60 vs. 28.1% in eGFR 30-60 vs. 48.4% in eGFR <30; p < 0.01). In diabetic foot infections, presenting eGFR severity did not affect rates of wound healing, time to heal, re-infection or amputation. However, decreasing eGFR was associated with increased mortality and re-hospitalization for infection at a different site. In this study, presenting eGFR was not a predictive value for wound healing or time until healing, however was associated with rehospitalization and overall mortality this diabetic foot population.
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NewsBot · Jun 26, 2025

Impact of Podiatric Surveillance on Amputation Rates in Patients with Diabetes and Chronic Kidney Disease
Stephanie Behme et al
Int J Low Extrem Wounds. 2025 Apr 29:15347346251337862

Development of the triad of peripheral arterial disease, peripheral neuropathy, and end stage renal disease puts people with diabetes at an increased risk of diabetic foot ulcerations and subsequent infections that often precede lower extremity amputations. In patients on hemodialysis, there is a ten-fold increased risk of amputation and an estimated 40%-82% one-year mortality rate if the amputation is a major amputation. This study aimed to examine if patients presenting to a podiatric clinic with stage 3a or 3b chronic kidney disease and a diabetic foot ulcer had decreased rates of amputations as compared to patients who presented after initiating dialysis. Our results demonstrated all major amputations occurred in patients who did not establish with podiatry prior to initiating HD. Additionally, our study revealed a potential access to care disparity for African American patients with chronic kidney disease, as African American patients were established with podiatry prior to initiating dialysis less often in comparison to Caucasian individuals. Our study lays the groundwork for future work investigating the impact of podiatric surveillance on patients with diabetes and end stage renal disease.
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NewsBot · Jul 2, 2025

Pathophysiology of Wound Development and Chronicity in Renal Disease: A Narrative Review
Kirtana Sandepudi et al
Int Wound J. 2025 Jul;22(7):e70713.

Renal disease, including chronic kidney disease (CKD) and end-stage renal disease (ESRD), has a profound impact on wound healing. Multiple studies have demonstrated that renal disease leads to an increased risk of diabetic foot ulcers, the formation of unique wounds like calciphylaxis, slower wound healing and a higher risk of amputation. This review details the interrelated mechanisms by which renal disease impacts wound healing. Motor and sensory neuropathies contribute to wound formation via foot deformities and decreased sensation. Neuropathies also decrease neuropeptide release, impairing angiogenesis and inflammatory regulation. Accumulation of uremic toxins in renal disease leads to vessel wall calcification, impairing blood supply and predisposing patients to calciphylaxis. Vitamin and mineral deficiencies lead to impaired clotting, development of a chronic inflammatory state and decreased collagen production. Renal disease and its comorbidities are also associated with immune dysregulation, increasing the risk of wound infections and promoting the persistence of pro-inflammatory macrophages. While hypoxia-inducible factor-1α (HIF-1α) promotes angiogenesis under hypoxic conditions in normal wound healing, oxidative stress and chronic hypoxia in renal disease generate an environment that compromises the activity of HIF-1α. Inadequate erythropoietin response to hypoxia also leads to anaemia, further impairing oxygen delivery to wound sites. Clinically, these factors result in increased 10-year mortality for patients with DFU and CKD compared to those with DFU alone, both with and without amputation. We must utilise our understanding of the pathophysiology of impaired wound healing in renal disease to target preventative measures, optimise treatment and improve overall outcomes.
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NewsBot · Jul 6, 2025

Impact of Podiatric Surveillance on Amputation Rates in Patients with Diabetes and Chronic Kidney Disease
Stephanie Behme et al
Int J Low Extrem Wounds. 2025 Apr 29:15347346251337862

Development of the triad of peripheral arterial disease, peripheral neuropathy, and end stage renal disease puts people with diabetes at an increased risk of diabetic foot ulcerations and subsequent infections that often precede lower extremity amputations. In patients on hemodialysis, there is a ten-fold increased risk of amputation and an estimated 40%-82% one-year mortality rate if the amputation is a major amputation. This study aimed to examine if patients presenting to a podiatric clinic with stage 3a or 3b chronic kidney disease and a diabetic foot ulcer had decreased rates of amputations as compared to patients who presented after initiating dialysis. Our results demonstrated all major amputations occurred in patients who did not establish with podiatry prior to initiating HD. Additionally, our study revealed a potential access to care disparity for African American patients with chronic kidney disease, as African American patients were established with podiatry prior to initiating dialysis less often in comparison to Caucasian individuals. Our study lays the groundwork for future work investigating the impact of podiatric surveillance on patients with diabetes and end stage renal disease.
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NewsBot · Jul 19, 2025

Renal Foot in Diabetes: Implications for Wound Healing and Solutions
Ashu Rastogi et al
Adv Wound Care (New Rochelle). 2025 Jul 17.

Significance: The prevalence of diabetes is increasing and so is diabetic foot disease (DFD). DFD encompasses diabetic foot ulcer (DFU), which is a major global health problem. DFD contributes to increased morbidity (reduced quality of life and lower limb amputation), a high rate of recurrence, and increased mortality. Patients with renal disease are at the highest risk of diabetes-related foot disease (renal foot). Recent Advances: Research has been undertaken in the last decade to understand the underlying causes leading to DFD in chronic kidney disease (CKD). The mechanisms, pathophysiology, biochemical, and immunological changes that occur in renal foot are being investigated and have given some insights into renal foot disease. Critical Issues: Patients with renal foot have multiple comorbidities, both systemic and local, that are peculiar to renal disease. Identification and treatment of existing comorbidities of anemia, hypoalbuminemia, immune dysfunction, vascular calcification, and limited life span are crucial to optimize outcomes in renal foot. Attention needs to be paid to nutrition deficiencies that can also adversely affect foot outcomes. Anticipated challenges in the management of infected DFU and endovascular interventions for peripheral arterial disease need to be studied. Compromised bone health in CKD complicates the management of Charcot foot in DFD. A better understanding of preulcer interventions that could be performed in patients with renal disease is lacking. Future Directions: Research focus on renal foot is required for delineating treatments that can be instituted to prevent DFD and disease progression in CKD. Intervention studies specifically targeting comorbidities in renal foot, such as peripheral vascular disease and cardiovascular disease, are required. Educating physicians and surgeons about the heightened risk of adverse consequences in renal foot is paramount. Multidisciplinary teams and one-stop foot/renal clinics shall ensure comprehensive care to improve outcomes in patients with renal foot.
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NewsBot · Dec 6, 2025

Association Between Diabetes-Related Lower-Extremity Amputations and Renal Function: An Observational, Single-Center, Retrospective Cohort Study
Yingxuan Cao et al
J Surg Res. 2025 Dec 4:317:61-71.

Introduction: The prevalence of lower-extremity amputation (LEA) in diabetic foot ulcer (DFU) patients has been well documented. Diabetic nephropathy is one of the major complications of diabetes. However, little is known about a potential relationship between renal function and LEA in DFU patients with renal insufficiency. This study aimed to examine the association between LEA and renal function in DFU patients with renal insufficiency, focusing on the changes of the estimated glomerular filtration rate (eGFR) and associated inflammatory markers pre- and postamputation.

Methods: A retrospective cohort study analyzed 240 patients with DFU between 2020 and 2023 at a single university center for treating diabetic foot. Patients were categorized into five groups based on baseline eGFR and into three groups according to postamputation changes in eGFR (improvement, stability, and deterioration). Univariate and multivariate logistic regression analyses were conducted to identify predictors of renal function changes following amputation. Key inflammatory markers evaluated included white blood cell count, neutrophil count, neutrophil percentage, neutrophil-to-lymphocyte ratio, and C-reactive protein (CRP).

Results: Lower baseline eGFR was associated with a higher risk of major amputation and more severe DFU. Postamputation, 66.2% of patients exhibited improved eGFR, with reductions in serum creatinine, blood urea nitrogen, cystatin C, and inflammatory markers such as CRP. Multivariate analysis identified Δ CRP as an independent protective factor for renal function changes after LEA.

Conclusions: LEA in patients with DFU, particularly those with renal insufficiency, may improve renal function postamputation, likely due to reduced systemic inflammation. Monitoring levels of CRP and other inflammatory markers levels pre- and postamputation could help predict renal function changes following amputation.
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NewsBot · Dec 13, 2025

Exploration of common therapeutic targets for diabetic nephropathy and diabetic foot ulcers by integrated bioinformatics analysis and experimental validation
Jiarong Liu et al
Mol Biol Rep. 2025 Dec 12;53(1):192.

Diabetes mellitus (DM), the ninth leading cause of death worldwide, is characterized by a relative or absolute deficiency of insulin, leading to increased production of advanced glycosylation end-products (AGEs), which further enhances oxidative and nitrosative stress, often leading to a variety of macrovascular and microvascular complications, such as diabetic nephropathy (DN), retinopathy, and neuropathy. Especially, diabetic patients with end stage renal disease (ESRD) usually have concomitant severe peripheral arterial disease. Unfortunately, there is still no effective therapeutic treatment for DM patients combined with DN and diabetic foot ulcer (DFU). Thus, we performed a series of bioinformatics analyses to investigated the molecular mechanisms involved in the occurrence of these two complications. We screened for differentially expressed genes (DEGs) from the Gene Expression Omnibus (GEO) database, namely GSE96804 and GSE134431, and conducted enrichment and protein-protein interaction analyses. Subsequently, we constructed animal models of these two diseases in vivo, and validated the predictions' accuracy using quantitative real-time PCR (qPCR) experiments to confirm the expression levels of mRNA. Finally, we conducted protein-chemical interactions and drug prediction. We identified 104 DEGs, with many of them being involved in inflammation or lipid metabolism. We obtained 7 hub genes closely related to DN and DFU, and verified through animal experiments that the expression trends of 5 of them (NID2, LUM, ECM, LTBP1 and LRRC2) were consistent with the results of bioinformatics analysis. Notably, our study showed that sex hormones including pirinixic acid, testosterone enanthate, and progesterone were predicted to be the most promising drugs, with the combined score of the three being the highest. This finding may potentially provide common therapeutic targets for DN and DFU. Additionally, it is important to understand these networks and hub genes to advance our understanding of the multifaceted complications of DM and the future development of drugs to treat these complications.
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NewsBot · Dec 26, 2025

How common? Exploring the prevalence and risk factors for Pseudomonas aeruginosa in diabetic foot infections among kidney transplant recipients
Mario Escoriza Gonzalez et al
Antimicrob Steward Healthc Epidemiol. 2025 Nov 28;5(1):e323.

Objective: Concern for Pseudomonas aeruginosa in diabetic foot infections (DFIs) is common and a driving factor for empiric antibiotic prescribing, particularly among immunocompromised hosts. This study sought to identify the prevalence of Pseudomonas aeruginosa in DFIs among kidney transplant recipients and the use of antipseudomonal agents for empiric antibiotic coverage.

Design: Retrospective cohort study.

Setting: Large, urban, tertiary care transplant center.

Patients: 39 kidney transplant recipients who developed DFIs at our institution between 2015-2023.

Methods: We performed a retrospective review of 47 DFIs in 39 kidney transplant recipients hospitalized for a DFI with a positive tissue culture.

Results: A total of 79 organisms were isolated. Pseudomonas represented 6.33% of organisms (5/79) and was present in 5/47 DFIs (10.6%). Staphylococcus aureus was the most commonly isolated organism (30.4%, 24/79). Compared to those with non-Pseudomonas infections, patients with cultures positive for Pseudomonas were temporally closer to transplant (50.6 days +/- 214.9 vs 1047.6 days +/- 766.4, p = 0.041) and more likely to have been treated for rejection with the past 12 months (2/5, 40% vs 0/42, 0%, p = 0.009). Eighty three percent of patients received empiric antibiotic coverage with an antipseudomonal agent.

Conclusions: Our study found a low overall prevalence of Pseudomonas in DFIs among kidney transplant recipients. Despite this, empiric coverage with antipseudomonal antibiotics was common, highlighting a potential antimicrobial stewardship target in solid organ transplantation.
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NewsBot · Jan 17, 2026

Analysis of Diabetic Foot Complication Factors in Type 2 Diabetes Mellitus Patients with Chronic Kidney Failure Complications: A Scoping Review
Ahmad Ya kub, Heri Kristianto, Lilik Supriati
J Foot Ankle Surg Asia-Pacific 2026; 13 (1):31-39.

Background: Diabetic foot (DF) is a serious complication frequently observed in patients with type 2 diabetes mellitus (DM), especially when accompanied by chronic kidney disease (CKD). It progresses from peripheral neuropathy and vascular impairment to foot ulcers, infection, and ultimately amputation. In CKD patients, immune dysfunction, systemic inflammation, and poor wound healing further worsen the clinical course. A comprehensive understanding of the multifactorial etiology of these complications is essential to improve clinical outcomes. Objective: This scoping review aims to examine the risk factors contributing to DF complications in patients with type 2 DM and CKD. Materials and methods: This review followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guidelines. A systematic literature search was conducted in PubMed, ProQuest, and ScienceDirect for studies published between 2019 and 2024, using the keywords “diabetes mellitus,” “diabetic foot complications,” and “chronic kidney failure.” Of 897 identified articles, nine met the inclusion criteria. This review protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD420251073723). Results: Key risk factors identified were anemia, peripheral arterial disease (PAD), chronic infection, gangrene, poor glycemic control, systemic inflammation, and immune dysfunction. Anemia impairs oxygen delivery and delays wound healing, while PAD and infection increase the risk of amputation and mortality. Conclusion: An integrated clinical approach is crucial to address the interplay between anemia, vascular impairment, infection, and metabolic dysregulation in CKD patients with DF complications. Early risk stratification and multidisciplinary interventions are recommended to improve patient outcomes.
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Renal failure and foot ulcer or lower extremity amputation in those patients with diabetes

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Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients

Musculoskeletal problems following renal transplant

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Renal failure and foot ulcer or lower extremity amputation in those patients with diabetes

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Podiatric Skin and Nail Involvement and Biomechanical Pathology in Renal Transplant Recipients

Musculoskeletal problems following renal transplant

ADRENALINA O TORNIQUETE

Necrosis in the toes following local anaesthesia with adrenaline--an urban legend?

Arenaline/Epinephrine as a masking agent?

EpiPen Adrenaline Autoinjector

Obtaining Adrenalin in the UK

Share This Page

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