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Med."],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the impact of autologous cell therapy on critical limb ischaemia in people with diabetes and diabetic kidney disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 59 people with diabetes (type 1 or type 2) and critical limb ischaemia, persisting after standard revascularization, were treated with cell therapy in our foot clinic over 7 years; this group comprised 17 people with and 42 without severe diabetic kidney disease. The control group had the same inclusion criteria, but was treated conservatively and comprised 21 people with and 23 without severe diabetic kidney disease. Severe diabetic kidney disease was defined as chronic kidney disease stages 4\u20135 (<jats:styled-content style=\"fixed-case\">GFR<\/jats:styled-content> &lt;30 ml\/min\/1.73 m\u00b2). Death and amputation\u2010free survival were assessed during the 18\u2010month follow\u2010up; changes in transcutaneous oxygen pressure were evaluated at 6 and 12 months after cell therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Transcutaneous oxygen pressure increased significantly in both groups receiving cell therapy compared to baseline (both <jats:italic>P<\/jats:italic>&lt;0.01); no significant change in either of the control groups was observed. The cell therapy severe diabetic kidney disease group had a significantly longer amputation\u2010free survival time compared to the severe diabetic kidney disease control group (hazard ratio 0.36, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.14\u20130.91; <jats:italic>P<\/jats:italic>=0.042); there was no difference in the non\u2010severe diabetic kidney disease groups. The severe diabetic kidney disease control group had a tendency to have higher mortality (hazard ratio 2.82, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.81\u20139.80; <jats:italic>P<\/jats:italic>=0.062) than the non\u2010severe diabetic kidney disease control group, but there was no difference between the severe diabetic kidney disease and non\u2010severe diabetic kidney disease cell therapy groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The present study shows that autologous cell therapy in people with severe diabetic kidney disease significantly improved critical limb ischaemia and lengthened amputation\u2010free survival in comparison with conservative treatment; however, the treatment did not influence overall survival.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.13985","type":"journal-article","created":{"date-parts":[[2019,5,11]],"date-time":"2019-05-11T15:39:04Z","timestamp":1557589144000},"page":"1133-1140","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of severe diabetic kidney disease on the clinical outcome of autologous cell therapy in people with diabetes and critical limb ischaemia"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2078-0177","authenticated-orcid":false,"given":"M.","family":"Dubsk\u00fd","sequence":"first","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Jirkovsk\u00e1","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Bem","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"N\u011bmcov\u00e1","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V.","family":"Fejfarov\u00e1","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Hazdrov\u00e1","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.","family":"Sutoris","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Chlup\u00e1\u010d","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Skibov\u00e1","sequence":"additional","affiliation":[{"name":"Institute for Clinical and Experimental Medicine Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. 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