{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:07Z","timestamp":1783509247521,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Dialysis therapy is associated with an increased incidence of lower-extremity wounds and amputations. We compared the incidence of foot ulcers and amputations before and after the start of dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We evaluated 150 consecutive diabetic patients receiving dialysis and compared the incidence of foot complications 30 months before and after initiation of hemodialysis. We used claims data for diabetes, ulceration, and dialysis and abstracted medical records to verify diagnoses and dates of ulcers and amputations. We compared initial and cumulative ulcer\/amputation incidence to account for multiple events in the same person over time. We used the same formula to determine the incidence rate difference and 95% confidence intervals (CIs) to compare new ulcers and amputations during the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There was no significant difference in the incidence of first foot ulcers before (91.7 per 1,000 patient-years; 95% CI, 73.7\u2013112.3 per 1,000 patient-years) and after (82.7; 95% CI, 65.7\u2013102.3) the start of hemodialysis. The incidence of cumulative ulcers was significantly higher before (304.0 per 1,000 patient-years; 95% CI, 270.8\u2013340.2) compared with after (210.7 per 1,000 patient-years; 95% CI, 183.0\u2013240.9) dialysis. There was no difference in the incidence of first amputation before (29.3 per 1,000 patient-years; 95% CI, 1 9.4\u201341.7 per 1,000 patient-years) and after (37.3 per 1,000 patient-years; 95% CI, 19.4\u201341.7 per 1,000 patient-years) dialysis or in the cumulative incidence of amputations before (61.3 per 1,000 patient-years; 95% CI, 46.7\u20138.4 per 1,000 patient-years) and after (58.7 per 1,000 patient-years; 95% CI, 44.5\u201375.5 per 1,000 patient-years) dialysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>There was no increase in the incidence of ulcers or amputations after beginning hemodialysis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/16-056","type":"journal-article","created":{"date-parts":[[2018,3,16]],"date-time":"2018-03-16T10:55:17Z","timestamp":1521197717000},"page":"1-5","source":"Crossref","is-referenced-by-count":4,"title":["Does the Start of Dialysis Initiate a Period of Increased Risk of Ulceration or Amputation?"],"prefix":"10.3390","volume":"108","author":[{"given":"Lawrence A.","family":"Lavery","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Lavery","sequence":"additional","affiliation":[{"name":"Aurora Statistical Consultants, Aurora, CO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan A.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Orthopedic and Spine Center of the Rockies, Fort Collins, CO."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javier La","family":"Fontaine","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan D.","family":"Lavery","sequence":"additional","affiliation":[{"name":"Texas Tech University, Dallas, TX."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"ref331","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1093\/ndt\/gfv114","article-title":"Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: a systematic review and meta-analysis","volume":"30","author":"Kaminski","year":"2015","journal-title":"Nephrol Dial Transplant"},{"key":"ref131","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1007\/s11892-007-0069-4","article-title":"Temperature monitoring to assess, predict, and prevent diabetic foot complications","volume":"7","author":"Lavery","year":"2007","journal-title":"Curr Diab Rep"},{"key":"ref241","doi-asserted-by":"crossref","first-page":"154","DOI":"10.2337\/dc07-1302","article-title":"Reevaluating the way we classify the diabetic foot: restructuring the diabetic foot risk classification system of the International Working Group on the Diabetic Foot","volume":"31","author":"Lavery","year":"2008","journal-title":"Diabetes Care"},{"key":"ref121","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1093\/ndt\/gfl241","article-title":"The effect of haemodialysis on transcutaneous oxygen tension in patients with diabetes: a pilot study","volume":"21","author":"Hinchliffe","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"ref271","doi-asserted-by":"crossref","first-page":"878","DOI":"10.2337\/dc09-2007","article-title":"High levels of foot ulceration and amputation risk in a multiracial cohort of diabetic patients on dialysis therapy","volume":"33","author":"Ndip","year":"2010","journal-title":"Diabetes Care"},{"key":"ref291","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1093\/ndt\/gfl241","article-title":"The effect of haemodialysis on transcutaneous oxygen tension in patients with diabetes: a pilot study","volume":"21","author":"Hinchliffe","year":"2006","journal-title":"Nephrol Dial Transplant"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"878","DOI":"10.2337\/dc09-2007","article-title":"High levels of foot ulceration and amputation risk in a multiracial cohort of diabetic patients on dialysis therapy","volume":"33","author":"Ndip","year":"2010","journal-title":"Diabetes Care"},{"key":"ref201","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.2337\/dc07-2244","article-title":"Association between renal failure and foot ulcer or lower-extremity amputation in patients with diabetes","volume":"31","author":"Margolis","year":"2008","journal-title":"Diabetes Care"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.diabres.2008.11.030","article-title":"Risk factors for developing osteomyelitis in patients with diabetic foot 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