Dr Kanzool Hasan1, Dr Shaun Chandler2, Professor Carmel Hawley3,5, Miss Elaine M Pascoe4, Dr Dharmenaan Palamuthusingam2,4,5, Professor David Johnson3,4,6, Professor Neil Boudville7, Dr Girish Talaulikar8, Professor Matthew D Jose9, Professor Stephen McDonald10,11,12, Dr Nick Cross13, Dr Magid Fahim3,4
1Canberra Health Services, Canberra, Australia, 2Royal Brisbane & Women’s Health Services, Herston, Australia, 3Australasian Kidney Trials Network (AKTN), University of Queensland, St Lucia, Australia, 4University of Queensland, St Lucia, Australia, 5Griffith University School of Medicine, Southport, Australia, 6NHMRC-National Health and Medical Research Council, Canberra, Queensland, 7University of Western Australia, Perth, Australia, 8Australian National University, Canberra, Australia, 9University of Tasmania, Hobart, Australia, 10Australia and New Zealand Dialysis and Transplant Registry(ANZDATA), , Australia & New Zealand, 11South Australia Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 12Adelaide Medical School, University of Adelaide, Adelaide, Australia, 13University of Otago, Dunedin, New Zealand
Biography:
I am a first year renal advanced trainee at Canberra Hospital. I am a UK medical graduate and I completed my basic physician training in Brisbane. Throughout my medical career, I was quite conflicted about which medical specialty to pursue after basic physician training. I even contemplated cardiology. I had an amazing experience as a BPT for the RBWH renal unit and decided to pursue nephrology. I am grateful to the RBWH and Canberra nephrologists for continuing to help me develop as a well-rounded nephrologist.
Aim:
To describe the trends in lower limb amputation in patients receiving kidney replacement therapy (KRT) across Australia and New Zealand.
Background:
Patients who receive KRT are at high risk of lower limb amputation, however recent studies have demonstrated decreasing rates of amputation in this population. Contemporary data regarding practice in Australia and New Zealand are lacking.
Methods:
Data linkage between ANZDATA and hospital admissions datasets across Australia and New Zealand was used to identify all registered patients receiving KRT between 2000-2015 who underwent lower limb amputation, excluding digital amputations. KRT was categorised as haemodialysis [HD], peritoneal dialysis [PD], home haemodialysis [HHD] and kidney transplant. Patients’ modalities were categorized each calendar year and amputation rates estimated using Poisson models.
Results:
In total, 46,971 patients were linked, of whom 1,506 underwent 1,706 amputations (60% were below knee amputations). Median age and vintage at the time of surgery were 62.3 years [IQR 54.2-69.6] and 2.76 years [1.2-5.6], respectively, 68% were male. The rates of amputation in dialysis patients (HD, PD and HHD) trended downwards from 3.6 (95%CI 2.4-4.8) in 2000 to 3.1 (95%CI 2.5-3.8) per 100 patient years, despite increasing prevalence of diabetes. Rates of amputation were highest in PD patients (1.2 per 100 patient years [95%CI 1.1-1.4]), and lowest in kidney transplant recipients (0.2 per 100 patient years [95%CI 0.1-0.3]). Amputations were >6 times higher in patients with diabetes mellitus than those without (1.3 vs. 0.2 per 100 patient years).
Conclusions:
Rates of amputation decreased by 14% over the 15-year period. The highest rates of amputation were seen in those receiving PD and patients with diabetes. Increased attention to preventative foot-care in these patients is warranted.
Presentation Slides PDF – Click Here