Author :
Abstract
Ayak ülserasyonlarının en iyi bilinen nedenlerinden biri diyabet olmasına rağmen, yapılan çalışmalarda diyaliz, son dönem böbrek yetmezliği ve kronik böbrek hastalığının ayakta ülserasyon gelişmesinde ve seyrinde, hatta alt ekstremite amputasyonları için bağımsız risk faktörleri olduğu kanıtlanmıştır. Yapılan çalışmalarda bu hasta gruplarında ayak ülserasyonları fiziksel-psikolojik sağlık, hareketlilik düzeyi, görme problemleri, beslenme durumu, sigara içme, hipoalbüminemi, düşük serum fosfor düzeyi, üremi, doku oksijenasyonu, üremik nöropati, periferik arter hastalığı, diyabet, anemi, alt ekstremitede ödem, enfeksiyonlara yatkınlık, diyaliz süresince ayak/bacakların bası altında kalması gibi nedenlerin yanısıra haftada iki ya da üç kez diyaliz tedavisi alma ile ilişkilendirilmektedir. Sonuç olarak diyabeti olan kişilerin ayak ülserasyonları açısından yüksek riskli kabul edildiği gibi, kronik böbrek yetmezliği olan yetişkinlerin de ayak ülserasyonu açısından büyük risk altında olduğu, diyabetli bireylere yapılan ayağa ilişkin değerlendirme ile eğitim ve bakım hizmetlerinin diyaliz tedavisi alan gruba da aynı önem ile verilmesinin gerekliliği ortadadır. Diyaliz hastaları genellikle diyaliz ortamının dışında bakımla temasını kaybederken, rutin diyaliz bakımının bir parçası olarak hemşireler tarafından değerlendirme, eğitim verme gibi koruyucu stratejiler ülserasyon ve amputasyon oranlarını azaltmak için anahtar olabilir. Bu derlemenin amacı ayak ülserasyonu gelişiminde kronik böbrek hastalığı ile ilişkili risk faktörlerini tanımlamaktır.
Keywords
Abstract
Although diabetes is one of the best-known causes of foot ulcerations, studies have proven that dialysis, end-stage renal disease and chronic kidney disease are independent risk factors for the development and course of foot ulceration, and even for lower extremity amputations. In the studies conducted, foot ulcerations in these patient groups were associated with receiving dialysis treatment 2 or 3 times a week as well as with the reasons such as physical-psychological health, mobility level, vision problems, nutritional status, smoking, hypoalbuminemia, low serum phosphorus level, uremia, tissue oxygenation, uremic neuropathy, peripheral arterial disease, diabetes, anemia, edema in the lower extremities, susceptibility to infections, pressure on the feet/legs during dialysis. As a result, it is obvious that people with diabetes are considered to be at high risk for foot ulcerations, adults with chronic renal failure are also at great risk for foot ulceration, the evaluation of the foot and the education and care services for individuals with diabetes should be given to the group receiving dialysis treatment with the same importance. While dialysis patients often lose touch with care outside of the dialysis setting, preventive strategies such as assessment and training by nurses as part of routine dialysis care may be the key to reducing ulceration and amputation rates. The purpose of this review is to describe the risk factors associated with renal failure in the development of foot ulceration.
Keywords
- 1. Afsar, B. & Akman, B. (2009). Depression and nonadherence are dosely related in dialysis patients. Kidney International, 76(6), 679.
- 2. Al Thani, H., El-Menyar, A., Hussein, A., Sadek, A., Sharaf, A., Singh, R., … Al Suwaidi, J. (2013). Prevalence, predictors and impact of peripheral arterial disease in hemodialysis patients: A cohort study with a 3-year follow-up. Angiology, 64(2), 98-104. https://doi.org/10.1177/0003319711436078
- 3. Al-Thani, H., El- Menyar, A., Koshy, V., Hussein, A., Sharaf, A., Asim, M. & Sadek, A. (2014). Implications of foot ulceration in hemodialysis patients: A 5-year observational study. Journal of Diabetes Research, Article ID 945075, 6 pages. http://dx.doi.org/10.1155/2014/945075
- 4. Allison, G. M. & Flanagin, E. (2020). How ESKD complicates the management of diabetic foot ulcers: The vital role of the dialysis team in prevention, early detection, and support of multidisciplinary treatment to reduce lower extremity amputations. Seminars in Dialysis, 33(3s), 245-253. https://doi. org/10.1111/sdi.12875
- 5. Beyene, R. T., Derryberry, S. L. Jr. & Barbul, A. (2020). The effect of comorbidi- ties on wound healing. The Surgical clinics of North America, 100(4), 695-705. https://doi.org/10.1016/j.suc.2020.05.002
- 6. Brand, S. L., Musgrove, A., Jeffcoate, W. J. & Lincoln, N. B. (2016). Evaluation of the effect of nurse education on patient-reported foot checks and foot care behaviour of people with diabetes receiving haemodialysis. Diabetic Medicine, 33(2), 204-7. https://doi.org/10.1111/dme.12831
- 7. Brekelmans, W., Borger van der Burg, B. L. S., Vroom, M. A., Kreuger, M. J., Sch- rander van der Meer, A. M. &Hoencamp, R. (2019). Prevalence of foot ulcers in dialysis-dependent patients. Wound Repair Regeneration, 27(6), 687-692. https://doi.org/10.1111/wrr.12750
- 8. Cozzolino, M., Ciceri, P., Galassi, A., Mangano, M., Carugo, S., Capelli, I. & Ci- anciolo, G. (2019). The key role of phosphate on vascular calcification. Toxins (Basel), 11(4), 213. https://doi.org/10.3390/toxins11040213
- 9. Demling, R. H. (2009). Nutrition, anabolism and the wound healing process: an overview. Eplasty, 9, e9.
- 10. De Vinuesa, S. G., Ortega, M., Martinez, P., Goicoechea, M., Campdera, F. G. & Luño, J. (2005). Subclinical peripheral arterial disease in patients with chronic kidney disease; prevalence and related risk factors. Kidney International Supplement, 93, S44-47. https://doi.org/10.1111/j.1523-1755.2005.09310.x
- 11. El Sharaawy, A. E. B., Ezzat, H., Mohab, A. & Elwasly, D. (2017). Association between renal function and diabetic foot ulcer in type 2 diabetic patients. International Journal of Advanced Research in Biological Sciences, 4(11), 7-15. http://dx.doi.org/10.22192/ijarbs.2017.04.11.002
- 12. Foster, S. (2017). High-risk foot and the effect of deteriorating renal functi- on and dialysis in people with diabetes. Journal of Diabetes Nursing, 21(1), 10–15.
- 13. Gilhotra, R. A., Rodrigues, B. T., Vangaveti, V. N., Kan, G., Porter, D., Sangla, K. S. & Malabu, U. H. (2016). Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective. Renal Failure, 38(7), 1036-1043. https://doi.org/10.1080/0886022X.2016.1193872
- 14. Han, G. & Ceilley, R. (2017). Chronic wound healing: a review of current mana- gement and treatments. Advances in Therapy, 34(3), 599-610.
- 15. Ikizler, T. A., Cano, N. J., Franch, H., Fouque, D., Himmelfarb, J., Kalantar-Zadeh, K., … Wanner, C. (2013). Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the international society of renal nutrition and metabolism. Kidney International, 84(6), 1096-1107. https://doi.org/10.1038/ki.2013.147
- 16. Kalantar-Zadeh, K. & Kopple, J. D. (2003). Trace elements and vitamins in ma- intenance dialysis patients. Advances in Renal Replacement Therapy, 10(3), 170-182. https://doi.org/10.1053/j.arrt.2003.09.002
- 17. Kaminski, M. R., Raspovic, A., McMahon, L. P., Lambert, K. A., Erbas, B., Mount, P. F., Kerr, P. G. & Landorf, K. B. (2017). Factors associated with foot ulceration and amputation in adults on dialysis: a cross-sectional observational study. BMC Nephrology, 18, 293.
- 18. Kaminski, M. R., Raspovic, A., McMahon, L. P., Strippoli, G. F. M., Palmer, S. C., Ruospo, M., Dallimore, S. & Landorf, K. B. (2015). Risk factors for foot ulceration and lower extremity amputation in adults with end-stage renal disease on di alysis: A systematic review and meta-analysis. Nephrology, dialysis, transplantation, 30(10), 1747-1766. https://doi.org/10.1093/ndt/gfv114
- 19. Kato, S., Chmielewski, M., Honda, H., Pecoits-Filho, R., Matsuo, S., … Lindholm, B. (2008). Aspects of immune dysfunction in end-stage renal disease. Clinical Journal of the American Society of Nephrology, 3(5), 1526-1533. https://doi. org/10.2215/CJN.00950208
- 20. Kay, D. B., Ray, S., Haller, N. A. & Hewit, M. (2011). Perfusion pressures and
- 21. Khanh, V. C., Ohneda, K., Kato, T., Yamashita, T., Sato, F., Tachi, K. & Ohneda, O. Uremic toxins affect the imbalance of redox state and overexpression of prolyl hydroxylase 2 in human adipose tissue-derived mesenchymal stem cells involved in wound healing. (2017). Stem Cells and Development, 26(13), 948-963. https://doi.org/10.1089/scd.2016.0326
- 22. Krishnan, A. V., Pussell, B. A. & Kiernan, M. C. (2009). Neuromuscular disease in the dialysis patient: A update for the nephrologist. Seminars in Dialysis, 22(3), 267-278. https://doi.org/10.1111/j.1525-139X.2008.00555.x
- 23. Lavery, L. A., Hunt, N. A., Lafontaine, J., Baxter, C. L., Ndip, A. & Boulton, A. J. (2010). Diabetic foot prevention: a neglected opportunity in high-risk patients. Diabetes Care, 33(7), 1460-1462.
- 24. Lavery, L. A., Lavery, D. C., Hunt, N. A., La Fontaine, J., Ndip, A. & Boulton, A. J. (2015). Amputations and foot-related hospitalisations disproportionately affect dialysis patients. International Wound Journal, 12(5), 523-526. https:// doi.org/10.1111/iwj.12146
- 25. Lewis, S., Raj, D. & Guzman, N. J. (2012). Renal failure: Implications of chronic kidney disease in the management of the diabetic foot. Seminars in Vascular Surgery, 25(2), 82-88. https://doi.org/10.1053/j.semvascsurg.2012.04.007
- 26. Lin, C. S., Chen, S. J., Sung, C. C., Lin, C. L., Lin, S. H., Cheng, S. M., … Kao, C. H. (2015). Hemodialysis is associated with increased peripheral artery occlusive disease risk among patients with end-stage renal disease: A nationwide population-based cohort study. Medicine (Baltimore), 94(28), e1164.
- 27. Lincoln, N. B., Radford, K. A., Game, F. L. & Jeffcoate, W. J. (2008). Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia, 51(11), 1954-1961.
- 28. Locking-Cusolito, H., Harwood, L., Wilson, B., Burgess, K., Elliot, M., Gallo, K., … Tigert, J. (2005). Prevalence of risk factors predisposing to foot problems in patients on hemodialysis. Nephrology Nursing Journal, 32(4), 373-384.
- 29. Margolis, D. J., Hofstad, O. & Feldman, H. I. (2008). Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes. Diabetes Care, 31(7), 1331-1336. https://doi.org/10.2337/dc07-2244
- 30. Marn Pernat, A., Peršič, V., Usvyat, L., Saunders, L., Rogus, J., Maddux, F. W.,… Kotanko, P. (2016). Implementation of routine foot check in patients with diabetes on hemodialysis: associations with outcomes. BMJ Open Diabetes Research Care, 4(1), e000158. doi: 10.1136/bmjdrc-2015-000158
- 31. Maroz, N. & Simman, R. (2014). Wound healing in patients with impaired kid- ney function. The journal of the American College of Clinical Wound Specialists, 5(1), 2-7.
- 32. Meuwese, C. L., Carrero, J. J. & Stenvinkel, P. (2011). Recent insights in inflam- mation-associated wasting in patients with chronic kidney disease. Contributions to Nephrology, 171, 120-126. https://doi.org/10.1159/000327228
- 33. Ndip, A., Lavery, L. A. & Boulton, A. J. M. (2010). Diabetic foot disease in peop- le with advanced nephropathy and those on renal dialysis. Current Diabetes Reports, 10(4), 283-290.
- 34. Ndip, A., Rutter, M. K., Vileikyte, L., Vardhan, A., Asari, A., Jameel, M., … Boul- ton, A. J. M. (2010). Dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and stage 4 or 5 chronic kidney disease. Diabetes Care, 33(8), 1811-1816. https://doi.org/10.2337/dc10-0255
- 35. Nigwekar, S. U., Wolf, M., Sterns, R. H. & Hix, J. K. (2008). Calciphylaxis from nonuremic causes: a systematic review. Clinical Journal of the American Society of Nephrology, 3(4), 1139-1143. https://doi.org/10.2215/CJN.00530108
- 36. Pappanas, N., Liakopoulos, V., Maltezos, E. & Stefanidis, I. (2007). The diabe- tic foot in end stage renal disease. Renal failure, 29(5), 519-528. https://doi. org/10.1080/08860220701391662
- 37. Reardon, R., Simring, D., Kim, B., Mortensen, J., Williams, D. & Leslie, A. (2020). The diabetic foot ulcer. Australian Journal of General Practice, 49(5), 250-255. doi: 10.31128/AJGP-11-19-5161
- 38. Reslerova, M. & Moe, S. M. (2003). Vascular calcification in dialysis patients: pathogenesis and consequences. American Journal of Kidney Disease, 41(3 Suppl 1), S96-99. https://doi.org/10.1053/ajkd.2003.50094
- 39. Rodriguez, P. G., Felix, F. N., Woodley, D. T. & Shim, E. K. (2008). The role of oxy- gen in wound healing: a review of the literature. Dermatologic Surgery, 34(9), 1159-69. https://doi.org/10.1111/j.1524-4725.2008.34254.x
- 40. Sabatino, A., Regolisti, G., Karupaiah, T., Sahathevan, S., Sadu Singh, B. K., Khor, B. H., … Fiaccadori, E. (2017). Protein-energy wasting and nutritional supplementation in patients with end-stage renal disease on hemodialysis. Clinical Nutrition, 36(3), 663-671. https://doi.org/10.1016/j.clnu.2016.06.007
- 41. Saluja, S., Anderson, S. G., Hambleton, I., Shoo, H., Livingston, M., Jude, E. B., Lunt, M., Dunn, G., Heald, A. H. (2020). Foot ulceration and its association with mortality in diabetes mellitus: a meta-analysis. Diabetic Medicine, 37(2), 211218. https://doi.org/10.1111/dme.14151
- 42. Scholnick, K. (2016). The effects of renal disease on wound healing. Podiatry Management, 35(2), 133-140.
- 43. Shroff, R. C., McNair, R., Figg, N., Skepper, J. N., Schurgers, L., Gupta, A. … Sha- nahan, C. M. (2008). Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation, 118(17), 1748-1757. https://doi.org/10.1161/CIRCULATIONAHA.108.783738
- 44. Thangarajah, H., Yao, D., Chang, E. I., Shi, Y., Jazayeri, L., Vial, I. N., … Gurtner, G. C. (2009). The molecular basis for impaired hypoxia-induced VEGF expression in diabetic tissues. Proceedings of the National Academy of Sciences of the United States of America, 106(32), 13505-13510.
- 47. Valabhji, J. (2012). Foot problems in patients with diabetes and chronic kid- ney disease. Journal of Renal Care, 38(Suppl 1), 99-108. https://doi.org/10.1111/j.1755-6686.2012.00284.x
- 48. Valabhji, J., Gibbs, R. G., Bloomfield, L., Lyons, S., Samarasinghe, D., Rosenfeld, P., … Bicknell, C. D. (2010). Matching the numerator with an appropriate denominator to demonstrate low amputation incidence associated with a London hospital multidisciplinary diabetic foot clinic. Diabetic Medicine, 27(11), 1304-1307. https://doi.org/10.1111/j.1464-5491.2010.03104.x
- 49. Van den Bosch, J., Warren, D. S. & Rutherford, P. A. (2015). Review of predialysis education programs: a need for standardization. Patient Preference and Adherence, 9, 1279-1291. https://doi.org/10.2147/PPA.S81284
- 50. Vanholder, R., Pletinck, A., Schepers, E. & Glorieux, G. (2018). Biochemical and clinical impact of organic uremic retention solutes: A comprehensive update. Toxins, 10(1), 33. https://doi.org/10.3390/toxins10010033
