ABSTRACT
The management of diabetic foot requires a rapid intervention in front of any type of wound, if possible by a multidisciplinary team. The daily diabetic foot screening is the best prevention. Peripheral neuropathy leads to articular deformations, loss of pain alert and skin dryness. Arteriopathy, which is also frequent, retards cicatrisation of wounds, with a higher risk of infection and amputation. Meticulous local care and foot pressure off-loading are essential, with, if needed, appropriate antimicrobial therapy. Surgery, with curative, preventive or even restorative interventions, occupies an increasing place. The evaluation, treatment and follow-up of the diabetic foot should follow new guidelines established by the IWGDF.
La prise en charge du pied diabétique doit être rapide face à toute plaie, si possible par une équipe multidisciplinaire. Le dépistage du pied à risque est la meilleure prévention. La neuropathie, sensitive, motrice et autonome, aboutit à des déformations, une perte de la protection algique et une sécheresse cutanée. Une artériopathie, également fréquente, hypothèque la cicatrisation des plaies, avec risque de surinfection et d'amputation. Les soins locaux et la mise en décharge sont essentiels, avec, si besoin, une antibiothérapie adaptée. La chirurgie curative mais aussi préventive, voire réparatrice, occupe une place grandissante. L'évaluation, le traitement et le suivi du pied diabétique répondent à des recommandations précises rédigées par l'IWGDF.
Subject(s)
Anti-Infective Agents , Diabetic Foot , Amputation, Surgical , Diabetic Foot/drug therapy , Diabetic Foot/surgery , Diabetic Foot/therapy , Guidelines as Topic , HumansABSTRACT
BACKGROUND: Obesity is a recognized risk factor for both the development and progression of chronic kidney disease (CKD). Accurate estimation of glomerular filtration rate (GFR) is thus important in these patients. We tested the performances of two creatinine-based GFR estimates, the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, in an obese population. METHODS: Patients with body mass index (BMI) > 30 kg/m(2) were included. The reference method for measured GFR (mGFR) was (51)Cr-EDTA (single-injection method, two blood samples at 120 and 240 min). Both indexed and non-indexed results were considered. Serum creatinine was measured using the IDMS-traceable compensated Jaffe method. Mean bias (eGFR-mGFR), precision (SD around the bias) and accuracy within 30% (percentage of estimations within 30% of mGFR) were calculated for both equations. RESULTS: The population included 366 patients (185 women) from two different areas. Mean age was 55 ± 14 years, and mean BMI was 36 ± 7 kg/m(2). Mean mGFR was 56 ± 26 mL/min/1.73 m(2) (71 ± 35 mL/min without indexation). In the total population, mean bias was +1.9 ± 14.3 and +4.6 ± 14.7 mL/min/1.73 m(2) (P < 0.05), and accuracy 30% was 80 and 76% for the MDRD and CKD-EPI equations (P < 0.05), respectively. In patients with mGFR > 60 mL/min/1.73 m(2), mean bias was +4.6 ± 18.4 and +9.3 ± 17.2 mL/min/1.73 m(2) (P < 0.05), and accuracy 30% was 81 and 79% (NS) for the MDRD and CKD-EPI equations, respectively. CONCLUSIONS: The CKD-EPI equation did not outperform the MDRD study equation in this population of obese patients.
