{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:26:42Z","timestamp":1793572002759,"version":"4.5.0"},"reference-count":25,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The International Journal of Lower Extremity Wounds"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic lower extremity ulcers (CLEU) are a significant health burden, often linked to complications such as diabetes and vascular diseases. Chronic kidney disease (CKD), a prevalent global health issue, has been increasingly associated with CLEU, though the nature of this relationship remains poorly understood. This study aimed to explore the association between CKD and CLEU in the US adult population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. The study included adults aged 20 years and older who completed interviews and examinations. CLEU was defined as self-reported ulcers or sores on the leg or foot lasting more than four weeks. CKD was diagnosed based on the 2012 KDIGO guidelines, using estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Logistic regression models were used to assess the association between CKD and CLEU, adjusting for demographics, BMI, lifestyle factors, and comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 8564 participants, individuals with CKD had a higher likelihood of developing CLEU, with an unadjusted odds ratio (OR) of 2.33 (95% CI: 1.86-2.91). After adjusting for confounders, the association remained significant, with adjusted ORs of 1.64 (95% CI: 1.26-2.12) and 1.57 (95% CI: 1.2-2.04) in Models 2 and 3, respectively. Stratified analyses showed no significant interactions across subgroups defined by age, sex, diabetes, hypertension, hyperlipidemia, and peripheral artery disease (PAD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study demonstrates a robust association between CKD and CLEU in US adults, suggesting that CKD is an independent risk factor for CLEU. These findings highlight the need for integrated management strategies for CKD patients to reduce the risk of CLEU. Future longitudinal studies are needed to establish causality and inform targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15347346251343707","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T03:23:02Z","timestamp":1747884182000},"page":"1248-1256","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Chronic Kidney Disease as an Independent Risk Factor for Chronic Lower Extremity Ulcers: A Cross-Sectional Analysis of US Adults"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9253-9083","authenticated-orcid":false,"given":"Hai","family":"Gao","sequence":"first","affiliation":[{"name":"The Second Affiliated Hospital of Nanchang University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanmin","family":"Yang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Nanchang University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaohui","family":"Wang","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Nanchang University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu","family":"Wu","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Nanchang University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4070-6297","authenticated-orcid":false,"given":"Yangyan","family":"Yi","sequence":"additional","affiliation":[{"name":"The Second Affiliated Hospital of Nanchang University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-475X.2009.00543.x"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mcna.2021.04.006"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.13953"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2019.07.012"},{"key":"e_1_3_2_6_2","unstructured":"Prevalence of Chronic Kidney Disease in the United States Chronic Kidney Disease JAMA JAMA Network. 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Accessed April 12 2025. https:\/\/pubmed.ncbi.nlm.nih.gov\/20484126\/."},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.2337\/dc07-2244"},{"key":"e_1_3_2_19_2","unstructured":"Frequency of risk factors for foot ulceration in individuals with chronic kidney disease - PubMed. Accessed April 12 2025. https:\/\/pubmed.ncbi.nlm.nih.gov\/18005131\/."},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfv114"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-012-0765-1"},{"key":"e_1_3_2_22_2","unstructured":"Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease New England Journal of Medicine. Accessed November 19 2024. https:\/\/www.nejm.org\/doi\/10.1056\/NEJMoa065485?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200www.ncbi.nlm.nih.gov."},{"key":"e_1_3_2_23_2","unstructured":"Pathophysiology of Calcium Phosphorus and Magnesium Dysregulation in Chronic Kidney Disease - Felsenfeld - 2015 - Seminars in Dialysis - Wiley Online Library. Accessed November 19 2024. https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/sdi.12411."},{"key":"e_1_3_2_24_2","unstructured":"Evolving Concepts on Inflammatory Biomarkers and Malnutrition in Chronic Kidney Disease - PMC. 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