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Foot Gangrene in Patients with End-Stage Renal Disease: A Case Control Study

Department of Vascular Surgery and Research Unit of CNRS, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France

Parinaz Ghaffari, MD

Unit of Vascular Medicine, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France

Eric Allaire, PhD

Department of Vascular Surgery and Research Unit of CNRS, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France

Hafedh Fessi, MD

Department of Nephrology and Research Unit of INSERM N°489, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France

Pierre Ronco, MD

Department of Nephrology and Research Unit of INSERM N°489, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France

Michel Vayssairat, MD

Unit of Vascular Medicine, UMR 7054, Tenon Hospital (Assistance Publique-Hôpitaux de Paris), University of Paris VI, Saint-Antoine Faculty of Medicine, Paris, France, michel.vayssairat{at}tnn.ap-hop-paris.fr

The prevalence of peripheral arterial disease (PAD) in patients with end-stage renal disease (ESRD) is high, with an annual risk of amputation estimated at 13%, and indications for limb revascularization in patients combining ESRD with stage IV PAD (foot gangrene) are still controversial. This case-controlled study compared survival, limb salvage, and quality of life in a group of patients hospitalized for foot gangrene according to their renal status (ESRD versus no renal insufficiency). All patients with ESRD hospitalized for foot gangrene (n=16) from 1996 to 2002 were compared with a control group with normal creatininemia (n=24) hospitalized for foot gangrene due to peripheral atherosclerotic arterial disease. The 2 groups were matched for age, sex ratio, and number with diabetes mellitus. After a mean follow-up of 467 ±410 days, patients with ESRD had a more severe prognosis as regards mortality (68.7% vs 12.5%, p=0.0005) and major amputation (31% versus 8%, p=0.09). The ESRD group was characterized by more frequent extensive arterial calcifications (16/16 vs 13/24, p=0.002), owing to a higher level of the calcium phosphorus product (3.54 ±1.2 vs 2.4 ±0.6, p=0.0023), and by impaired microcirculatory perfusion, as indicated by a lower oxygen pressure (TcPO₂) (15.6 ±12 mm Hg vs 26 ±16, p=0.07). ESRD implies a poor prognosis in patients with stage IV peripheral arterial disease.

Angiology, Vol. 57, No. 3, 355-361 (2006)
DOI: 10.1177/000331970605700312


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