Establishing Foot Assessment Frequency in Dialysis Patients Using a Flowchart Based on the WIfI

Abstract

 Hemodialysis patients have a high risk of lower extremity arterial occlusive disease, making early detection of foot lesions essential. To support nurses in determining individualized foot check frequency, we developed a flowchart integrating WIfI stage with risk factors including ankle–brachial index (ABI), limb discoloration, diabetes, and revascularization history. Outpatients receiving dialysis at our hospital were evaluated using this flowchart from October 2023 to October 2024. Nurses adjusted foot check frequency at each visit and shared information with a multidisciplinary team. As a result, foot check frequency decreased, while the distribution of WIfI stages was unchanged. Furthermore, referrals for endovascular treatment increased from one to six cases, with no additional amputations.

 Our findings suggest that the flowchart enabled nurses to determine foot check frequency from a unified perspective, strengthened team-based monitoring of lesion changes, and promoted shared awareness of potential problems. This approach contributed to early detection and appropriate intervention in dialysis patients.