The Dialysis Foot- the Impact of Presenting Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients Hospitalized With Diabetic Foot Infections

Authors

Arthur Tarricone
Tyler L Coye
Allen Gee
Bijan Najafi
Michael C Siah
Lawrence A Lavery

Publication Date

5-1-2025

Journal

International Wound Journal

DOI

10.1111/iwj.70122

PMID

40320291

PMCID

PMC12050157

PubMedCentral® Posted Date

5-4-2025

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Humans, Diabetic Foot, Male, Female, Glomerular Filtration Rate, Retrospective Studies, Aged, Middle Aged, Wound Healing, Hospitalization, Aged, 80 and over, Amputation, Surgical, Cohort Studies, chronic kidney disease, diabetic foot infection, eGFR, foot, osteomyelitis

Abstract

To evaluate the association between presenting estimated glomerular filtration rate (eGFR) and clinical outcomes in patients hospitalized with diabetic foot infections. This retrospective cohort study included 344 patients with moderate to severe diabetic foot infections. Patients were categorized into three groups based on presenting estimated eGFR: eGFR ≥60 (eGFR >60 mL/min), eGFR 30-60 (eGFR 30-60 mL/min) and eGFR < 30 (eGFR < 30 mL/min). Outcomes assessed included wound healing, time to heal, re-infection, amputation, mortality and re-hospitalization for infection. Compared with patients with eGFR < 30, patients with eGFR ≥60 had significantly lower rates of retinopathy, peripheral arterial disease and use of beta blockers or calcium channel blockers. Glycated haemoglobin levels were inversely related to eGFR, decreasing as eGFR severity increased. Haemoglobin levels were significantly lower, and inflammatory markers (ESR and CRP) were significantly higher in patients with eGFR < 30. There were no significant differences among eGFR groups in rates of wound healing, time to heal, re-infection or amputation. However, mortality increased with decreasing eGFR (1.9% in eGFR ≥60 vs. 3.2% in eGFR 30-60 vs. 8.1% in eGFR < 30; p = 0.04). Similarly, re-hospitalization for infection at a different site also increased with decreasing eGFR (20.5% in eGFR ≥60 vs. 28.1% in eGFR 30-60 vs. 48.4% in eGFR < 30; p <  0.01). In diabetic foot infections, presenting eGFR severity did not affect rates of wound healing, time to heal, re-infection or amputation. However, decreasing eGFR was associated with increased mortality and re-hospitalization for infection at a different site. In this study, presenting eGFR was not a predictive value for wound healing or time until healing, however was associated with rehospitalization and overall mortality this diabetic foot population.