Epidemiology of Lower Limb Disease In Persons with Chronic Kidney Disease
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Lower limb complications (foot ulcers and lower limb amputations) are major problems commonly seen in patients with peripheral vascular disease (PVD) and chronic kidney disease (CKD). Lower limb complications are a significant cause of suffering and reduced quality of life. The association between CKD and development of lower limb complications has been well studied, however, the opposite is not true. We sought to determine how interim lower limb complications modify the subsequent risk of progression to kidney failure, all-cause mortality prior to kidney failure and cardiovascular events in a cohort of stage 3-5 CKD patients. We performed a retrospective cohort study of 92,618 individuals using patient level data obtained by linking several administrative databases from Manitoba, Canada. The rate of kidney failure, all-cause mortality prior to kidney failure and cardiovascular related hospitalization were significantly higher in persons experiencing an interim lower limb complication. After adjusting for baseline characteristics and co-morbidities, experiencing an interim lower limb complication increased the risk of progressing to kidney failure, all-cause mortality and cardiovascular related hospitalization by more than 2-fold. Clinical trials of screening and treatment strategies for CKD patients experiencing lower limb complications is urgently needed.