Abstract
Peripheral arterial disease (PAD) is one of the serious complications that can arise in patients on hemodialysis. The prognosis of critical limb ischemia due to PAD is extremely poor. Therefore, it is important to evaluate and treat such patients at an early stage. In this regard, we designed a risk stratification and foot care program (the Kamakura classification), which divided hemodialysis patients into six stages based on the presence of foot lesions and PAD. The Kamakura classification also indicates the type and frequency of foot care required. We started this foot care program for the hemodialysis patients in our hospital in August 2011. As a result, the incidence of foot ulceration fell significantly from 4.9 cases/100 person-years prior to the introduction of the care program to 3.1 cases/100 person-years in the first year and 1.5 cases/100 person-years in the second year (p=0.03). Furthermore, the incidence of amputation decreased from 1.6 cases/100 person-years prior to the introduction of the care program to 1.0 cases/100 person-years in the first year and 0.5 cases/100 person-years in the second year. Thus, the incidence of amputation fell, but not significantly (p=0.14). Furthermore, we compared the ankle-brachial pressure index and toe-brachial pressure index values of patients with or without foot lesions. Both parameters were significantly lower in the patients with foot lesions. Therefore, both PAD and foot lesions seem to be important markers for classifying the risk for PAD. In conclusion, a foot care program based on the Kamakura classification was found to be useful for reducing the incidence of foot ulceration in hemodialysis patients with PAD. The provision of continuous foot care at an early stage played an important role in this improvement.
