Association between Diabetic Kidney Disease and Diabetic Foot Ulceration

Abstract

Diabetic kidney disease (DKD) is a common global health challenge characterized by a decline in renal function among the diabetic population, which progresses to end-stage renal disease (ESRD). Evidence in the literature suggests a strong association between DKD and the development of diabetic foot ulceration (DFU). DFU is a serious health issue that complicates both type 1 and type 2 diabetes mellitus, and negatively impacts the quality of life of diabetic patients. Patients with advanced DKD or ESRD have a five-fold increased risk of developing DFU, with 6.5–10 times higher rate of amputation than their non-nephropathic counterparts. Multiple and inter-related pathways of DFU in DKD have been identified in which ischemia, neuropathy and infection are major contributing pathologies. However, extensive research to comprehensively assess the progression of DFU in DKD is lacking. In this chapter, we discuss the causal pathways in DFU development and progression, the relationship between DKD and DFU as well as treatment options and measures to achieve both primary and secondary prevention.