RESULTS OF LOWER-EXTREMITY AMPUTATIONS IN PATIENTS WITH END-STAGE RENAL-DISEASE

Purpose: The purpose of this study was to determine the impact of end- stage renal disease (ESRD) on the outcome of patients undergoing lower extremity (LE) amputation. Methods: Hospital charts and vascular surg ery registry data were reviewed for all patients who underwent LE ampu tation over a consecutive 56-month period. The results of 84 patients with ESRD (137 amputations) were compared with 375 patients (442 amput ations) without ESRD. Results: Hospital mortality rate was significant ly greater in patients with ESRD than patients without ESRD, 24% versu s 7% (p = 0.001). Patients with ESRD undergoing minor amputations had mortality rates three times greater than patients without ESRD undergo ing major LE amputations. In patients with ESRD requiring bilateral or unilateral above-knee amputation hospital mortality rates were 43% an d 38%, respectively. In addition, patients with ESRD were seven times more likely to undergo bilateral amputation than patients without ESRD over a mean follow-up period of 17 months. No kidney transplant patie nts died after amputation. Conclusion: ESRD has a profound negative im pact on morbidity, mortality, and survival rates after LE amputation. Attempts at prevention of amputation with aggressive foot care and pat ient education in this high-risk group should be the focus of therapy.