There is an “urgent need” for targeted interventions for people with both diabetic foot ulcer and chronic kidney disease who face a greater risk of major adverse cardiovascular events, researchers say.
A new study set out to examine the combined impact of chronic kidney disease (CKD) and ulcer severity on incident cardiovascular events in people with diabetes-related foot ulceration.
Describing this particular group of people as “very high risk”, the team behind the study said: “While both ulcer severity and CKD independently associate with adverse outcomes, their combined impact seems more substantial, suggesting an urgent need for targeted interventions, closer attention to underlying cardiac disease states, multidisciplinary management strategies, and upstream prevention.”
Both diabetic foot ulceration (DFU) and chronic kidney disease are serious complications of diabetes, each independently associated with a greater risk of cardiovascular disease (CVD), the leading cause of mortality among patients with diabetes.
The Australian study, which involved 497 patients, used the SINBAD (site, ischaemia, neuropathy, bacterial infection, area, depth) classification to define ulcer severity, with patients categorised into four groups based on SINBAD and CKD category.
The results showed that severe DFU with CKD amplifies the risk of major adverse cardiovascular events (MACE) in patients with DFU, with the study authors saying this has important implications for cardiovascular risk assessment.
They concluded: “In patients with DFU, an already high-risk cohort, those with the combination of a high SINBAD score and CKD represent a unique and susceptible group with a disproportionately higher risk of cardiovascular events.
“Further studies are needed to investigate whether targeted therapeutic approaches and the integration of models of care that address the complex interplay between DFU, CKD, and cardiovascular disease can improve outcomes in this very high-risk cohort.”
The study was led by Girish Dwivedi, from the Centre of Excellence for Cardiometabolic Health at Fiona Stanley and Fremantle Hospitals Group, and Emma J. Hamilton, from the hospital group’s Centre of Excellence Multidisciplinary Diabetes Foot Ulcer Service.
Read the paper in Physiological Reports.
