Renal Foot in Diabetes: Implications for Wound Healing and Solutions

Significance: The prevalence of diabetes is increasing and so is diabetic foot disease (DFD). DFD encompasses diabetic foot ulcer (DFU), which is a major global health problem. DFD contributes to increased morbidity (reduced quality of life and lower limb amputation), a high rate of recurrence, and increased mortality. Patients with renal disease are at the highest risk of diabetes-related foot disease (renal foot). Recent Advances: Research has been undertaken in the last decade to understand the underlying causes leading to DFD in chronic kidney disease (CKD). The mechanisms, pathophysiology, biochemical, and immunological changes that occur in renal foot are being investigated and have given some insights into renal foot disease. Critical Issues: Patients with renal foot have multiple comorbidities, both systemic and local, that are peculiar to renal disease. Identification and treatment of existing comorbidities of anemia, hypoalbuminemia, immune dysfunction, vascular calcification, and limited life span are crucial to optimize outcomes in renal foot. Attention needs to be paid to nutrition deficiencies that can also adversely affect foot outcomes. Anticipated challenges in the management of infected DFU and endovascular interventions for peripheral arterial disease need to be studied. Compromised bone health in CKD complicates the management of Charcot foot in DFD. A better understanding of preulcer interventions that could be performed in patients with renal disease is lacking. Future Directions: Research focus on renal foot is required for delineating treatments that can be instituted to prevent DFD and disease progression in CKD. Intervention studies specifically targeting comorbidities in renal foot, such as peripheral vascular disease and cardiovascular disease, are required. Educating physicians and surgeons about the heightened risk of adverse consequences in renal foot is paramount. Multidisciplinary teams and one-stop foot/renal clinics shall ensure comprehensive care to improve outcomes in patients with renal foot.