Rehabilitation outcomes in patients with lower limb amputation receiving haemodialysis: A retrospective cohort study

Yoshitaka Wada; Yohei Otaka; Yuki Senju; Hiroshi Hosokawa; Takamichi Tohyama; Hirofumi Maeda; Masahiko Mukaino; Seiko Shibata; Satoshi Hirano

doi:10.2340/jrmcc.v5.2525

Authors

Yoshitaka Wada Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan https://orcid.org/0000-0003-2191-3629
Yohei Otaka Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan https://orcid.org/0000-0002-6797-2782
Yuki Senju Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan
Hiroshi Hosokawa Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan
Takamichi Tohyama Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan
Hirofumi Maeda Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan
Masahiko Mukaino Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan https://orcid.org/0000-0003-4348-8715
Seiko Shibata Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan https://orcid.org/0000-0003-3607-7547
Satoshi Hirano Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Japan

DOI:

https://doi.org/10.2340/jrmcc.v5.2525

Keywords:

activities of daily living, comorbidity, amputation, renal dialysis, rehabilitation, haemodialysis, ower limb amputation

Abstract

Objective: To compare the functional outcomes of patients with lower limb amputations receiving haemodialysis and those not receiving haemodialysis.
Design: A retrospective cohort study. Patients: Patients with lower limb amputation who were admitted to a convalescent rehabilitation ward between January 2018 and December 2021.
Methods: The primary outcome was the effectiveness of the Functional Independence Measure (FIM) during hospitalisation in the ward. Secondary outcomes included the total and subtotal (motor/cognitive) FIM scores at discharge, gain in the total and subtotal (motor/cognitive) FIM scores, K-level at discharge, length of hospital stay in the ward, rehabilitation time, and discharge destination. Outcomes were compared between the non-haemodialysis and haemodialysis groups.
Results: A total of 28 patients (mean [standard deviation] age, 67.0 [11.9] years; men, 20) were enrolled in this study. Among them, 11 patients underwent haemodialysis. The FIM effectiveness was significantly higher in the non-haemodialysis group than in the haemodialysis group (median [interquartile range], 0.78 [0.72 – 0.81] vs 0.65 [0.28 – 0.75], p = 0.038). The amount of rehabilitation and all secondary outcomes were not significantly different between the groups (p > 0.05).
Conclusion: Patients with lower limb amputation who were receiving haemodialysis had poorer FIM effectiveness than those not receiving haemodialysis.

LAY ABSTRACT
Chronic kidney disease is a risk factor for foot ulcers and lower limb amputation. Thus, patients with lower limb amputation often require maintenance dialysis. However, there is a lack of knowledge on whether patients with lower limb amputation receiving haemodialysis can achieve functional outcomes comparable to those not receiving haemodialysis. This study aimed to compare functional outcomes between patients with lower limb amputations receiving haemodialysis and those not receiving haemodialysis. This retrospective cohort study enrolled 28 patients who underwent amputation surgery and were admitted to a rehabilitation ward, including 11 patients undergoing haemodialysis (8 with diabetic nephropathy, 1 with chronic glomerulonephritis, 1 with rapidly progressive glomerulonephritis, and 1 with acute kidney injury). Although the amount of rehabilitation did not differ between groups, the improvement in the activities of daily living was significantly better in the non-haemodialysis group than in the haemodialysis group. Thus, even the same amount of rehabilitation for patients with lower limb amputations receiving haemodialysis may not lead to functional outcomes comparable to those without haemodialysis.