The impact of creatinine clearance on the outcome of diabetic foot ulcers in north Indian tertiary care hospital

AimWound healing has been reported to be poor in diabetic patients with impaired kidney functions that usually accompanies retinopathy and neuropathy. The insensitive foot is vulnerable to repeated trauma and development of ulcer precedes 70–80% of non-traumatic lower extremity amputation. The present study was aimed to study the impact of creatinine clearance (CCre) on the outcome of diabetic foot ulcers (DFU).Materials and methodsData from 162 DFU patients admitted to Rajiv Gandhi Centre for Diabetes and Endocrinology of J.N. Medical College, Aligarh Muslim University, Aligarh, India, between December 2009 and March 2011 were analyzed. Detailed history and patient's profile, grade of DFU, co-morbidities and complications, laboratory data, microbiological profile and final outcome were collected. CCre was calculated according to MDRD formula.ResultsThe study revealed that, DFU healing was worst in patients with decreased CCre than in those who had normal CCre. Other factors associated with poor outcome were, higher grade of ulcer, infection type (subcutaneous and osteomyelitis) and biofilm infection. Amputation rates were also found to be higher in those with poor renal functions.ConclusionsThe results suggest that CCre is an important factor affecting wound healing in patients with DFUs. The automatic reporting of eGFR each time a serum creatinine concentration is requested will increase the awareness of significant kidney dysfunction in clinical practice especially in DFU patients and appropriate measures will improve the outcome.

► Creatinine clearance was associated with impaired wound healing in diabetic foot ulcers. ► A significant association between end stage renal disease and the failure of trans-metatarsal amputations to heal was found. ► Biofilm infection in foot ulcer was also found to be an independent and the most important significant factor for CCre study. ► DFU patients who have impaired kidney functions are at increased risk of poor wound healing leads to amputation. ► Automatic reporting of eGFR will increase the awareness of significance of kidney dysfunction.