Résumé
Introduction: Diabetes is the leading cause of non-traumatic lower limb amputation and end-stage renal disease (ESRD). Monitoring of the risk of diabetic foot wounds is guided by the recommendations of the International Working Group for Diabetic Foot (IWGDF), in particular through the gradation of the podiatric risk. Although chronic kidney disease (CKD) is a known risk factor for diabetic foot wounds, the relationship between CKD stage and IWGDF foot risk grade has never been explored. The purpose of the study was to analyze the relationship between CKD stage and foot grade according to IWGDF 2019.
Materials and Methods: We conducted a bi-centric cross-sectional study. All patients were recruited from Diabetes or Nephrology outpatient’s clinic. Foot risk gradation was established during the consultation. Renal function was estimated based on a recent biologic workup.
Results: We included 250 patients between November 2019 and August 2020. Podiatric risk grade was associated with stage of renal failure (p<0.001) and dialysis (<0.001). The best sensitivity/specificity ratio to predict a podiatric risk grade 2 or 3 was 33ml/min/1.73m2 (AUC curve ROC 0.740). Nevertheless, if there was a difference in foot risk grade between patients with ESRD and each of the other CKD stages. There was no difference in foot risk grade between the other CKD stages. Age, smoking, diabetic retinopathy and albuminemia were associated with foot grade in multivariate analysis.
Conclusion: There is an association between podiatric risk grade and stage of CKD. This link is dominated by the impact of dialysis. There is interest in strengthening collaborations between dialysis centers, Nephrologists and diabetic foot expert centers with enhanced therapeutic and prevention education programs. A clearance of 30ml/min/1.73m2 appears as a relevant alert threshold to predict a podiatric risk grade 2 or 3.