| Objective:Diabetic foot(diabetic foot,DF)and diabetic nephropathy are common complications of diabetes mellitus(diabetes mellitus,DM).However,the prevalence of chronic kidney disease(chronic kidney disease,CKD)among DM patients with DF is unknown.Accor-dingly,we conducted a cross-sectional study at a tertiary hospital to explore the prevalence of CKD among DF patients.Methods:In this cross-sectional study,all in-patients were treated in the Qianfoshan Hospital,Shandong University from May 2015 to October 2018.The exclusion criteria were as follows:1)age<18 years;2)pregnant women;3)infection,such as pulmonary infection,abdominal infection and urinary tract infection;and 4)presence of malignant disease,heart failure and severe liver disease.After excluding patients meeting these criteria,a total of42,132 diabetic patients were enrolled.Among these patients,477 DF patients had data for at least one standardized foot examination.Additionally,116 patients with incomplete data were also excluded.Therefore,a total of 361 DF patients were eligible for analysis in the study.Zhang Luxia et al.conducted a cross-sectional study aimed at exploring the preva-lence of CKD in general Chinese inpatients.In their study,a total of 871,742 adult CKD patients,aged 18 years or older,were included in the study from July 2013 to June 2014.Additionally,we compared the prevalence of CKD in DF patients with that of general Chinese inpatients.Seven hundred twenty-two non-DF patients were sex-and age-matched with DF patients and were randomly selected as controls.The sample sizes for each age-stratified group,≤40,41-50,51-60,61-70,and>70 years,were 10,54,124,228,and306 non-DF patients,respectively.We compared the CKD prevalence of DF patients with non-DF patients in China.Estimated glomerular filtration rate(estimated glomerular filtra-tion rate,e GFR)was calculated using the Chronic Kidney Disease Epidemiology Colla-boration(CKD-EPI)equation.CKD was defined as decreased renal function(e GFR<60ml/min/1.73 m~2)or the presence of proteinuria(urine protein≥1+).Multivariable regret-ssion analysis was performed to explore the relationship between different variables in patients with CKD and DF.Results:A total of 361 DF patients were enrolled,the mean age was 67.9±12.2 years(26 to 99years);63.7%(n=230)were males,and 36.3%(n=131)were females.The mean e GFR was 80.3 m L/min/1.73 m~2.Among all participants,34.1%(n=123)had decreased renal function,29.9%(n=108)had proteinuria and 49.0%(n=177)had CKD.Overall,14.4%(n=52)of patients had CKD stage 3,4.4%(n=16)had CKD stage 4 and 15.2%(n=55)had CKD stage 5.The rate of missed diagnoses for CKD was 59.9%.Then DF patients were divided into three groups according to age:group 1(18-44 years),group 2(45-64years)and group 3(≥65 years).In males,the percentage of CKD in group 2 was higher than group 1 and group 3.However,in females,the percentage of CKD in group 3 was higher than in group 2.In total,the prevalence of CKD in our study was 49.0%,which was higher than that of the general inpatients in China(4.5%).Furthermore,the percentage of CKD in group 1(50.0%vs 3.1%),group 2(54.4%vs 4.5%)and group 3(46.0%vs 6.0%)was higher than that of the general Chinese inpatients.Meanwhile,DF patients and non-DF patients were divided into five groups according to age:group 1(≤40 years),group 2(41-50 years),group 3(51-60 years),group 4(61-70 years)and group 5(>70years).Except for group 5 and in females,the prevalence of CKD in DF patients was higher than in non-DF patients.In total,the prevalence of CKD in non-DF patients was39.3%,which was lower than DF patients.In the univariate logistic regression analysis,hypertension,uric acid,homocysteine and triglycerides were correlated with CKD.After adjusting for potential confounders,uric acid,homocysteine and Hb A1c were significantly correlated with CKD with adjusted ORs of 1.49(95%CI,1.22 to 1.82),1.05(95%CI,1.00to 1.10)and 1.23(95%CI,1.04 to 1.47),respectively.Conclusion:This study revealed that the prevalence of CKD among DF patients was high,and special attention should be paid to these patients. |
