Value of Estimated Glomerular Filtration Rate in Type 2 Diabetic Patients with Foot Ulcers

Abstract

Diabetic foot syndrome and diabetic nephropathy are major complications of diabetes mellitus and increase morbidity and mortality of those with the disease. Patients suffering from diabetes have a 12–25% lifetime risk of developing a foot ulcer and about 20–30% risk for developing diabetic nephropathy. Foot complications are encountered at a more than twofold frequency in diabetic patients with end-stage renal disease, and the rate of amputations is 6.5-10 times higher in comparison to the general diabetic population. The majority of studies have focused on foot ulcers in late stages of CKD or dialysis patients. There are surprisingly very little data regarding the relationship between diabetic foot complications and renal insufficiency in predialysis patients with diabetes. The present study is a cross sectional observational study of 75 adult patients with type 2 DM who were recruited from surgical and medical units of Ain Shams University Hospitals. The aim of the study is to evaluate possible association between degree of renal function in form of eGFR with diabetic foot ulcers in patients with type 2 DM. The patients were divided into 2 groups based on physical examination. Group1 included 50 patients with active foot ulcers and group 2 included 25 without past history or current evidence of foot ulceration. The present study showed that patients with foot ulcers were significantly older , had longer duration of diabetes and were more on treatment with insulin compared to patients without foot ulcers. On the other hand both groups were comparable regarding gender, body mass index, smoking status, treatment with oral hypoglycemics, biguanides or glitazones. Our study also revealed that patients with diabetic foot ulcers had a higher systolic blood pressure, higher incidence of peripheral neuropathy ; and more stroke compared to patients with no foot ulcers. However, there was no significant difference between patients with and without foot ulcers regarding presence of hypertension, means diastolic blood pressure, presence of retinopathy, or presence of ischemic heart disease. Patients with DFU showed higher incidence of history of lower limb amputations and poor glycemic control in form of a higher HbA1c values compared to patients without foot ulcers. Both groups were comparable regarding other evidences of peripheral vascular disease in form of mean Ankle Brachial Index, absence of dorsalis pedis pulsations, absence of posterior tibia pulsations, performance of revascularization or performance of angiography.