Epidemiology of Lower Limb Disease in Persons with Chronic Kidney Disease

Abstract

Chronic kidney disease (CKD) is a major public health problem with an increasing incidence and prevalence worldwide. Patients with CKD, and particularly those with kidney failure on dialysis, have exceedingly high rates of cardiovascular disease. Diabetes is the leading cause of CKD, and patients with CKD and diabetes encounter multiple micro and macrovascular complications. Of these, foot complications culminating in amputation can be devastating for morbidity, mortality and health related quality of life. While the prevalence of diabetic foot disease (neuropathy, ulcerations, ischaemia, amputations, osteomyelitis, skin and soft tissue infections) and lower limb amputations in patients with kidney failure (on dialysis) has been studied, very little is known about the epidemiology of these diseases in non‐dialysis CKD. We have recently combined the laboratory information system database from Diagnostic Services of Manitoba, with the administrative databases housed at the Manitoba Center for Health Policy. These linkages have allowed us to create a cohort of over 20,000 patients with CKD, 5000 with kidney failure, all of whom have detailed information on physician claims, and medication use. In the proposed BSc Med program, we will conduct an epidemiological investigation into the burden of lower limb complications (ulcerations, peripheral vascular disease, and amputations) in persons with CKD. Our specific aims are as follows 1)‐ Determine the incidence and prevalence of peripheral vascular disease (PVD), diabetic foot disease, and lower limb amputations in patients with CKD and kidney failure 2)‐ Determine the association of PVD, diabetic foot disease and amputations with subsequent morbidity and mortality in this population 3)‐ Identify practice pattern variations in the optimal management of PVD to inform future interventional studies.