Deficiencies in foot care of diabetic patients on renal replacement therapy

Diabetic patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) are known to be at very high risk of foot ulceration causing significant morbidity and mortality. We surveyed the foot care of all diabetic patients in our area having RRT for ESRD over a three-month period. Of the 55 patients included, 36 (65.5%) had not been seen in a diabetes clinic and 32 (58.2%) had not been seen by a podiatrist in the preceding year. Of all patients, 36 had previous documented evidence of high-risk feet yet only 21 (58.3%) of this group had been seen by a podiatrist in the year before. Active ulceration was known to be present in seven patients. Ulcer duration was between 16 and 66 (mean 33) weeks. Three patients with active ulceration had not been seen by a podiatrist and four had not been seen in diabetes clinic in the previous year. In view of the worrying deficiencies in foot care in this group, we suggest increasing podiatry and diabetes team access for RRT patients at the site of their dialysis and advocate early multidisciplinary foot clinic referral for patients with ulceration.

~Practical Diabetes International~