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Incidence and Recovery of Acute Kidney Injury in Diabetic and Nondiabetic Patients with Foot Infections

Easton C. RyanUniversity of Texas Southwestern Medical School, Dallas, TX.

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Peter Andrew CrisologoDepartment of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Orhan K. OzDepartment of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.

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Javier La FontaineDepartment of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Dane K. WukichDepartment of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Matthew MaloneSouth West Sydney Limb Preservation and Wound Research Academic Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia.

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Lawrence A. LaveryDepartment of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.

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Background: The aim of this study was to evaluate the incidence and recovery of acute kidney injury (AKI) in patients admitted to the hospital with and without diabetes mellitus (DM) with foot infections.

Methods: We retrospectively reviewed 294 patients with DM and 88 without DM admitted to the hospital with foot infections. The Kidney Disease: Improving Global Outcomes guidelines were used to define AKI. Recovery was divided into three categories: full, partial, and no recovery within 90 days of the index AKI.

Results: The AKI incidence was 3.0 times higher in patients with DM (DM 48.5% versus no DM 23.9%; 95% confidence interval [CI], 1.74–5.19; P < .01). Acute kidney injury incidence was similar at each stage in people with and without DM (stage 1, DM 58.1% versus no DM 47.6%; stage 2, DM 23.3% versus no DM 33.3%, and stage 3, DM 18.6% versus no DM 19.1%). Twenty-nine patients with diabetes had a second AKI event and four had a third event. In patients without DM, one patient had a second AKI. Cumulative AKI incidence was 4.7 times higher in people with DM (DM 60.9% versus no DM 25.0%; 95% CI, 2.72–8.03; P < .01). Patients with diabetes progressed to chronic kidney disease or in chronic kidney disease stage 39.4% of the time. Patients without diabetes progressed 16.7% of the time, but this trend was not significant (P = .07). Complete recovery was 3.8 times more likely in patients without diabetes (95% CI, 1.26–11.16; P = .02).

Conclusions: Acute kidney injury incidence is higher in patients with diabetes, and complete recovery after an AKI is less likely compared to patients without diabetes.

Corresponding author: Easton C. Ryan, BS, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. (E-mail: peter.crisologo@utsouthwestern.edu)