Comparison of the risk of non-traumatic lower extremity amputation between haemodialysis and peritoneal dialysis patients with end-stage renal disease

Aim: We used insurance claims data of Taiwan to compare the risk of non-traumatic lower extremity amputation between haemodialysis (HD) and peritoneal dialysis (PD) patients. Methods: We identified 77 669 HD patients and 10 035 PD patients without prior amputation from 2000 to 2010. Incidence rates and hazard ratios (HRs) of lower extremity amputation, and subsequent 30-day mortality after amputation were evaluated up to 31 December 2011. Results: There were 2427 and 216 patients undergoing lower extremity amputation during follow-up in the HD and PD groups with incidence rates of 8.35 and 5.79 per 1000 person-years, respectively. Compared with the HD group, the overall adjusted HR of lower extremity amputation for the PD group was 1.27 (95% CI = 1.10–1.46). The impact of diabetes status on the risk of lower extremity amputation interacted with dialysis modality significantly (P < 0.001). Compared with the corresponding HD patients, the PD patients with diabetes had an adjusted HR of 1.44 (95% CI = 1.24–1.67) for amputation, whereas those without diabetes had an adjusted HR of 0.58 (95% CI = 0.36–0.95). The subsequent 30-day mortality rates after amputation were not significantly different between the HD and PD groups (8.45% vs. 9.72%) with an adjusted odds ratio of 1.41 (95% CI = 0.87–2.28, PD versus HD). Conclusion: Compared with corresponding HD patients, the amputation risk is higher for PD patients with diabetes, while the risk is lower for PD patients without diabetes. Dialysis patients have a high 30-day mortality risk after amputation.