The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration
Abstract In patients with diabetes‐related foot ulceration (DFU), ulcer severity and chronic kidney disease (CKD) portend worse outcomes. We evaluated the combined impact of a severe ulcer with CKD on major adverse cardiovascular events (MACE) in patients with DFU. Ulcer severity was defined using t...
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Wiley
2025-06-01
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| Series: | Physiological Reports |
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| Online Access: | https://doi.org/10.14814/phy2.70415 |
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| author | Nick S. R. Lan Jonathan Hiew Ivana Ferreira J. Carsten Ritter Laurens Manning P. Gerry Fegan Emma J. Hamilton Girish Dwivedi |
| author_facet | Nick S. R. Lan Jonathan Hiew Ivana Ferreira J. Carsten Ritter Laurens Manning P. Gerry Fegan Emma J. Hamilton Girish Dwivedi |
| author_sort | Nick S. R. Lan |
| collection | DOAJ |
| description | Abstract In patients with diabetes‐related foot ulceration (DFU), ulcer severity and chronic kidney disease (CKD) portend worse outcomes. We evaluated the combined impact of a severe ulcer with CKD on major adverse cardiovascular events (MACE) in patients with DFU. Ulcer severity was defined using the SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) classification, dividing into low (1–3) or high (4–6). CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Patients were categorized into four groups based on SINBAD and CKD category. MACE was defined as hospitalization for myocardial infarction, stroke or transient ischemic attack, or heart failure. Of 497 patients, 236 (47.5%) were SINBAD‐low/CKD‐absent, 80 (16.1%) SINBAD‐high/CKD‐absent, 127 (25.6%) SINBAD‐low/CKD‐present, and 54 (10.9%) SINBAD‐high/CKD‐present. The median follow‐up was 410 (interquartile range 242–576) days for MACE and 387 (221–549) days for MACE or all‐cause mortality. SINBAD‐high/CKD‐present was associated with significantly higher MACE (SINBAD‐low/CKD‐absent 4.2%; SINBAD‐high/CKD‐absent 7.5%; SINBAD‐low/CKD‐present 9.5%; SINBAD‐high/CKD‐present 33.3%; log‐rank p < 0.001) and MACE or all‐cause mortality (SINBAD‐low/CKD‐absent 5.5%; SINBAD‐high/CKD‐absent 13.8%; SINBAD‐low/CKD‐present 17.4%; SINBAD‐high/CKD‐present 53.7%; log‐rank p < 0.001). SINBAD‐high/CKD‐present was associated with MACE (p < 0.001) and MACE or all‐cause mortality (p < 0.001) after multivariate adjustment. Severe DFU with CKD amplifies the risk of MACE in patients with DFU, suggesting important implications for cardiovascular risk assessment. |
| format | Article |
| id | doaj-art-69c0b3c091bf4c7789d3e2bf7ddf21de |
| institution | Kabale University |
| issn | 2051-817X |
| language | English |
| publishDate | 2025-06-01 |
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| series | Physiological Reports |
| spelling | doaj-art-69c0b3c091bf4c7789d3e2bf7ddf21de2025-08-20T03:45:10ZengWileyPhysiological Reports2051-817X2025-06-011311n/an/a10.14814/phy2.70415The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulcerationNick S. R. Lan0Jonathan Hiew1Ivana Ferreira2J. Carsten Ritter3Laurens Manning4P. Gerry Fegan5Emma J. Hamilton6Girish Dwivedi7Centre of Excellence for Cardiometabolic Health Fiona Stanley Hospital Perth AustraliaCentre of Excellence Multidisciplinary Diabetes Foot Ulcer Service Fiona Stanley and Fremantle Hospitals Group Perth AustraliaCentre of Excellence Multidisciplinary Diabetes Foot Ulcer Service Fiona Stanley and Fremantle Hospitals Group Perth AustraliaCentre of Excellence Multidisciplinary Diabetes Foot Ulcer Service Fiona Stanley and Fremantle Hospitals Group Perth AustraliaMedical School The University of Western Australia Perth AustraliaMedical School Curtin University Perth AustraliaMedical School The University of Western Australia Perth AustraliaCentre of Excellence for Cardiometabolic Health Fiona Stanley Hospital Perth AustraliaAbstract In patients with diabetes‐related foot ulceration (DFU), ulcer severity and chronic kidney disease (CKD) portend worse outcomes. We evaluated the combined impact of a severe ulcer with CKD on major adverse cardiovascular events (MACE) in patients with DFU. Ulcer severity was defined using the SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) classification, dividing into low (1–3) or high (4–6). CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. Patients were categorized into four groups based on SINBAD and CKD category. MACE was defined as hospitalization for myocardial infarction, stroke or transient ischemic attack, or heart failure. Of 497 patients, 236 (47.5%) were SINBAD‐low/CKD‐absent, 80 (16.1%) SINBAD‐high/CKD‐absent, 127 (25.6%) SINBAD‐low/CKD‐present, and 54 (10.9%) SINBAD‐high/CKD‐present. The median follow‐up was 410 (interquartile range 242–576) days for MACE and 387 (221–549) days for MACE or all‐cause mortality. SINBAD‐high/CKD‐present was associated with significantly higher MACE (SINBAD‐low/CKD‐absent 4.2%; SINBAD‐high/CKD‐absent 7.5%; SINBAD‐low/CKD‐present 9.5%; SINBAD‐high/CKD‐present 33.3%; log‐rank p < 0.001) and MACE or all‐cause mortality (SINBAD‐low/CKD‐absent 5.5%; SINBAD‐high/CKD‐absent 13.8%; SINBAD‐low/CKD‐present 17.4%; SINBAD‐high/CKD‐present 53.7%; log‐rank p < 0.001). SINBAD‐high/CKD‐present was associated with MACE (p < 0.001) and MACE or all‐cause mortality (p < 0.001) after multivariate adjustment. Severe DFU with CKD amplifies the risk of MACE in patients with DFU, suggesting important implications for cardiovascular risk assessment.https://doi.org/10.14814/phy2.70415cardiovascular diseaseschronic kidney diseasecoronary artery diseasediabetesfoot ulcermyocardial infarction |
| spellingShingle | Nick S. R. Lan Jonathan Hiew Ivana Ferreira J. Carsten Ritter Laurens Manning P. Gerry Fegan Emma J. Hamilton Girish Dwivedi The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration Physiological Reports cardiovascular diseases chronic kidney disease coronary artery disease diabetes foot ulcer myocardial infarction |
| title | The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration |
| title_full | The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration |
| title_fullStr | The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration |
| title_full_unstemmed | The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration |
| title_short | The combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes‐related foot ulceration |
| title_sort | combined impact of chronic kidney disease and ulcer severity on incident cardiovascular events in patients with diabetes related foot ulceration |
| topic | cardiovascular diseases chronic kidney disease coronary artery disease diabetes foot ulcer myocardial infarction |
| url | https://doi.org/10.14814/phy2.70415 |
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