TOPLINE:

Among patients who underwent dialysis, those with diabetes as either the primary renal disease (PRD) or a comorbidity had a higher risk for lower limb amputation than those without. These patients also had a substantially higher mortality rate within 1 year following amputation.

METHODOLOGY:

• Researchers conducted a cohort study from 2003 to 2017 to assess the incidence, outcomes, intercentre variation, and key risk factors for lower limb amputation among incident dialysis patients in England.
• Overall, 69,701 patients were categorised into three groups: those with diabetes as the PRD (n = 21,061; median age, 64.4 years; 63.6% men), diabetes as a comorbidity (n = 7973; median age, 71.2 years; 64.6% men), and no diabetes (n = 40,667; median age, 65.4 years; 62.7% men).
• The date of the first non‑traumatic, non‑malignant lower limb amputation within 3 years of dialysis initiation was identified for each patient, and amputations were classified as minor (occurring at the toe, foot, or ankle) or major (occurring below or above the knee).
• The study also analysed mortality within 1 year following lower limb amputation.

TAKEAWAY:

• During the follow-up period, 9.1% of patients with diabetes as the PRD, 2.6% of those with diabetes as a comorbidity, and 0.6% of those without diabetes underwent lower limb amputation.
• Diabetes as the PRD (adjusted subdistribution hazard ratio [sHR], 9.29), diabetes as a comorbidity (adjusted sHR, 3.64), history of prior lower limb amputation (adjusted sHR, 2.19), and peripheral vascular disease (adjusted sHR, 2.11) were identified as key risk factors for lower limb amputation.
• Mortality within 1 year following minor or major lower limb amputation was 38%, 52%, and 48% in diabetes as the PRD, diabetes as a comorbidity, and no diabetes groups, respectively; among patients undergoing either a minor or major amputation, those with diabetes as the PRD had a standardised mortality ratio of 34.7 compared with the general population.
• Rates of major amputation declined over time by 2.5% annually in the diabetes as the PRD group and 5.6% annually in the no diabetes group, whereas rates of minor amputation remained stable; a significant intercentre variation in amputation rates was observed, with adjusted rates ranging from 2.01 to 11.71 per 100 patient-years.

IN PRACTICE:

"We show a high cumulative incidence of LLA [lower limb amputation] within 3 years of dialysis initiation, particularly those with PRD diabetes and a very high one-year mortality across all groups with unchanged minor amputation rates and substantial inter-centre variation," the authors wrote.

SOURCE:

This study was led by Nithin Bodapati, UK Renal Registry, Bristol, England. It was published online on February 24, 2026, in Clinical Kidney Journal.

LIMITATIONS:

This study lacked data on glycaemic control, smoking status, and unit-level foot care practices. There may have been variations in coding practices, particularly for minor amputations. Patient-centred outcomes such as quality of life and functional independence were not captured. Additionally, the data were limited to patients up to 2016, so more recent trends were not assessed.

DISCLOSURES:

This study did not receive any funding from any agency. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.