*Association between Diabetic Kidney Disease and Diabetic Foot Ulceration DOI: http://dx.doi.org/10.5772/intechopen.107825*

respectively [115]. Similarly, compared to the general diabetic population, a 10-times increase in nontraumatic amputation rate was reported, as seen in 11.8–13.8/100 person-years in diabetic patients on dialysis [98], while diabetes mellitus was identified as the main risk factor for amputation of lower limb among patients on hemodialysis [122]. Tragically, the rates of mortality among amputees receiving dialysis therapy are disproportionately high regardless of successful post-amputation rehabilitation. For example, 50% mortality was reported within 1 year in 14 diabetic patients receiving dialysis therapy compared to 33% 1-year mortality rate in diabetic patients receiving treatment for heart failure [123]. Also, a study involving a large cohort of diabetic patients revealed increased post-amputation mortality rates, which corresponded with worsening renal condition, with dialysis patients being the most affected [124]. As infection (or sepsis) is a principal aggravating factor in DFU development and progression, it has been identified as a contributing factor next to cardiovascular disease in the mortality of diabetic patients on dialysis. A case-control study that sought to investigate the rates of mortality following diabetes-associated amputation revealed sepsis as a major cause of post-amputation mortality (49% of cases) compared to mortality due to heart-related diseases (45%) [125]. Although the authors did not include diabetic patients receiving dialysis therapy in their study, the implication of their findings is very important, as diabetic patients receiving dialysis treatment are easily vulnerable to infection. On a whole, dialysis increases the rate of DFU onset and progression as well as lower limb amputation and post-amputation mortality.
