diabetic foot and renal disease

Diabetic foot disease is one of the most costly complications of diabetes in the UK, and frequently co-occurs with chronic kidney disease (CKD), including end-stage renal disease, in people with diabetes. In addition to the common pathologies underlying each complication of diabetes it is not clear whether each may have an influence on the other. Those with end- stage renal disease are at particular risk of the development of diabetic foot disease, and this risk increases dramatically when renal replacement therapy commences. However, it is now also recognised that the presence of a diabetes-related foot ulcer may accelerate decline in renal function, such that the commencement of renal replacement therapy may be advanced. Potential mechanisms for this include chronic inflammation with circulating inflammatory cytokines and/or repeated episodes of acute kidney injury, particularly in those who have hospital admissions for their diabetic foot disease. Given the poor outcome of foot disease and CKD in this patient cohort, renal units and diabetes foot services should work closely together to ensure that patients are seen regularly by preventative podiatry services, and to ensure that pathways are in place for rapid referral should new foot disease be noticed.