Nontraumatic lower extremity amputations in the Medicare end-stage renal disease population

Background Nontraumatic lower limb amputation is a serious complication of both diabetic neuropathy and peripheral vascular disease. Many people with end-stage renal disease (ESRD) suffer from advanced progression of these di seases. This study presents descriptive information on the rate of lower li mb amputation among people with ESRD who are covered by the Medicare progra m. Methods. Using hospital bill data for the years 1991 through 1994 from the Health Care Financing Administration's ESRD program management and medical information system (PMMIS), amputations were based on ICDB coding. These ho spitalizations were then linked back to the PMMIS enrollment database for c alculation of rates. Results. The rate of lower limb amputation increased during the four-year p eriod from 4.8 per 100 person years in 1991 to 6.2 in 1994. Among persons w hose renal failure was attributed to diabetic nephropathy, the rates in 199 1 and 1994 were 11.8 and 13.8, respectively. The rate among diabetic person s with ESRD was 10 times as great as among the diabetic population at large . Two thirds died within two years following the first amputation. Conclusions. The ESRD population is at an extremely high risk of lower limb amputation. Coordinated programs to screen for high-risk feet and to provi de regular foot care for those at high risk combined with guidelines for tr eatment and referral of ulceration are needed.