Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population

Paul W. Eggers, Dorothy Gohdes, Jacqueline A Pugh

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

Background. Nontraumatic lower limb amputation is a serious complication of both diabetic neuropathy and peripheral vascular disease. Many people with end-stage renal disease (ESRD) suffer from advanced progression of these diseases. This study presents descriptive information on the rate of lower limb amputation among people with ESRD who are covered by the Medicare program. Methods. Using hospital bill data for the years 1991 through 1994 from the Health Care Financing Administration's ESRD program management and medical information system (PMMIS), amputations were based on ICD9 coding. These hospitalizations were then linked back to the PMMIS enrollment database for calculation of rates. Results. The rate of lower limb amputation increased during the four-year period from 4.8 per 100 person years in 1991 to 6.2 in 1994. Among persons whose renal failure was attributed to diabetic nephropathy, the rates in 1991 and 1994 were 11.8 and 13.8, respectively. The rate among diabetic persons with ESRD was 10 times as great as among the diabetic population at large. Two thirds died within two years following the first amputation. Conclusions. The ESRD population is at an extremely high risk of lower limb amputation. Coordinated programs to screen for high-risk feet and to provide regular foot care for those at high risk combined with guidelines for treatment and referral of ulceration are needed.

Original languageEnglish (US)
Pages (from-to)1524-1533
Number of pages10
JournalKidney International
Volume56
Issue number4
DOIs
StatePublished - 1999
Externally publishedYes

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Medicare
Amputation
Chronic Kidney Failure
Lower Extremity
Management Information Systems
Population
Foot
Diabetic Angiopathies
Centers for Medicare and Medicaid Services (U.S.)
Peripheral Vascular Diseases
Diabetic Neuropathies
Diabetic Nephropathies
Disease Management
Renal Insufficiency
Disease Progression
Hospitalization
Referral and Consultation
Databases
Guidelines

Keywords

  • Diabetic nephropathy
  • Gangrene
  • Leg amputation
  • Peripheral vascular disease
  • Ulceration

ASJC Scopus subject areas

  • Nephrology

Cite this

Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. / Eggers, Paul W.; Gohdes, Dorothy; Pugh, Jacqueline A.

In: Kidney International, Vol. 56, No. 4, 1999, p. 1524-1533.

Research output: Contribution to journalArticle

Eggers, Paul W. ; Gohdes, Dorothy ; Pugh, Jacqueline A. / Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population. In: Kidney International. 1999 ; Vol. 56, No. 4. pp. 1524-1533.
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