An investigation of foot morbidity in patients with end stage renal disease on dialysis

Abstract

Aim: To determine the prevalence of foot morbidity amongst patients with End Stage Renal Disease on dialysis treatment. Methods: A prospective single centre, non-experimental, non-randomized quantitative time series design was employed. The sample was recruited using convenience sampling. The study was carried out at the Renal Unit, Mater Dei Hospital, Malta. Forty seven patients were recruited (a total of 94 limbs). Baseline data was gathered via an initial consultation with the participant whereby medical reports were also reviewed followed by various noninvasive foot assessments which included: Neurological, Arterial, Biomechanical, and Dermatological Assessments. Participants were assessed twice during the study. At the time of recruitment (Time 0) and after six months (Time 1), the Toe Brachial Pressure Index (TBPI), Spectral Doppler Waveform Analysis, and the Quantitative Sensory Testing (QST) were measured at each visit. Results: The prevalence of foot morbidity was found to be high amongst participants with ESRD on dialysis. 95.74% of participants presented with foot deformities, whilst 76.60% presented with skin and nail conditions. 22% of participants had a history of ulceration, 19% had a history of amputation, 9% had active ulceration, and 7% had history of revascularisation. Findings demonstrated an overall poor foot health and footcare behaviour within this population with 40.43% of participants presenting with inappropriate footwear, 70% did not check feet regularly, 87% did not attend to podiatry appointments, whilst 68% were unable to reach their feet for self-care. The mean TBPI decreased during the study period (6months). Albeit not statistically significant, one should not dismiss the reduction in TBPI which indicates that TBPI decreases with time in this specific cohort. The relationship between the TBPI and duration of dialysis was found to be significant and also compliments the reduction of TBPI with time. Both Diabetes Mellitus and dialysis duration were identified as significant predictors for the reduction in TBPI. Results indicated that for every one month increase in dialysis duration, the TBPI was expected to decrease by 0.013 and that the mean TBPI for patients with DM and ESRD was expected to be 0.1565 less than the mean TBPI of patients with ESRD. Conclusion: This study has shed light on the high prevalence of foot morbidity amongst the cohort of patients with ESRD on dialysis within the renal unit in Malta. This study highlighted the importance of expanding practice by introducing a new podiatry service within the renal unit to provide prompt foot screening, foot care, and foot care education, with the aim to reduce severe foot complications. Indeed, the study recommended that End Stage Renal Disease patients on dialysis should embark on a podiatry screening algorithm as soon as they are diagnosed with this condition and continue to be reviewed and monitored closely within the renal unit to delay and/or prevent severe outcomes.