Chronic Kidney Disease as an Independent Risk Factor for Chronic Lower Extremity Ulcers: A Cross-Sectional Analysis of US Adults

BackgroundChronic lower extremity ulcers (CLEU) are a significant health burden, often linked to complications such as diabetes and vascular diseases. Chronic kidney disease (CKD), a prevalent global health issue, has been increasingly associated with CLEU, though the nature of this relationship remains poorly understood. This study aimed to explore the association between CKD and CLEU in the US adult population.MethodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2004. The study included adults aged 20 years and older who completed interviews and examinations. CLEU was defined as self-reported ulcers or sores on the leg or foot lasting more than four weeks. CKD was diagnosed based on the 2012 KDIGO guidelines, using estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR). Logistic regression models were used to assess the association between CKD and CLEU, adjusting for demographics, BMI, lifestyle factors, and comorbidities.ResultsAmong 8564 participants, individuals with CKD had a higher likelihood of developing CLEU, with an unadjusted odds ratio (OR) of 2.33 (95% CI: 1.86-2.91). After adjusting for confounders, the association remained significant, with adjusted ORs of 1.64 (95% CI: 1.26-2.12) and 1.57 (95% CI: 1.2-2.04) in Models 2 and 3, respectively. Stratified analyses showed no significant interactions across subgroups defined by age, sex, diabetes, hypertension, hyperlipidemia, and peripheral artery disease (PAD).ConclusionThis study demonstrates a robust association between CKD and CLEU in US adults, suggesting that CKD is an independent risk factor for CLEU. These findings highlight the need for integrated management strategies for CKD patients to reduce the risk of CLEU. Future longitudinal studies are needed to establish causality and inform targeted interventions.