.

A disturbingly high prevalence of single or bilateral lower extremity amputations in our program prompted us to conduct a study to identify the prevalence of risk factors that predispose patients on hemodialysis (HD) to foot problems. The study consisted of a one-time assessment of subjects’ risk for and actual prevalence of amputation. The sample consisted of 232 subjects – 56% male, 44% female. Ages ranged from 21-91 years, mean age 65.1 and median age 69 years. The most common comorbidities were hypertension (75%), coronary artery disease (50%), diabetes (42.2%), hyperlipidemia (34.9%), and peripheral vascular disease (27.2%), which are all established risk factors for peripheral arterial occlusive disease. Twenty-one percent of subjects were current smokers; 28% were former smokers. Nearly 13.4% of subjects had undergone amputations ranging from single toes to bilateral above knee amputations. Only 31% of subjects had both bilateral palpable pedal pulses present. Neuropathy, as evidenced by the inability to feel the application of monofilaments to 10 sites on each foot or the presence of symptoms, was present in 74.6% of subjects. Only 2.6% of subjects demonstrated comprehensive self-care behaviors (SCBs). With respect to subjects’ ability for self-care, 75% of subjects had adequate vision, 60% adequate dexterity, and 55% adequate flexibility to perform self-care. Study findings confirmed impressions that patients are at considerable risk for foot complications. Implications for nursing practice include regular foot assessment, education for self-care, and referral to specialists when required.                                                                                      

Heather Locking-Cusolito, RN, MScN, CNeph(C), is Nurse Practitioner/Clinical Nurse Specialist, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, Ontario, Canada, and is a member of the Michigan chapter of ANNA.

Lori Harwood, RN, MSc, CNeph(C), is Nurse Practitioner/Clinical Nurse Specialist, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, Ontario, Canada, and is a member of the Michigan chapter of ANNA.

Barbara Wilson, RN, MScN, CNeph(C), is Nurse Practitioner/Clinical Nurse Specialist, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, Ontario, Canada, and is a member of the Michigan chapter of ANNA.

Kathy Burgess, RN, is Staff Nurse, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, Ontario, Canada.

Marlene Elliot, RN, is Staff Nurse, London Health Sciences Centre, University Hospital, London, Ontario, Canada, and is a member of the Michigan chapter of ANNA.

Kerri Gallo, RN, CNeph(C),is Staff Nurse, Nephrology Research Coordinator/Dialysis and Plasmapheresis Staff Nurse, London Health Sciences Centre, London, Ontario, Canada.

Janice Ische, RN, was Staff Nurse, Adam Linton Hemodialysis Unit, Victoria Hospital, London Health Sciences Centre, Ontario, Canada, at the time this article was written.

Julie Ann Lawrence-Murphy, RN(EC), MScN, CNeph(C), is Nurse Practitioner/Clinical Nurse Specialist, London Health Sciences Centre, University Hospital, London, Ontario, Canada.

Jane Ridley, RN, MScN, CNeph(C),is Nurse Practitioner/Clinical Nurse Specialist, London Health Sciences Centre, University Hospital, London, Ontario, Canada, and is a member of the Michigan chapter of ANNA.

Margaret Robb, RN, CNeph(c), is Staff Nurse, London Health Sciences Centre, University Hospital, London, Ontario, Canada.

Cheryl Taylor, RN, was Staff Nurse, Adam Linton Hemodialysis Unit, London Health Sciences Centre, London, Ontario, Canada, at the time this article was written.

Judy Tigert, RN, MscN, CNeph(C),is Nurse Practitioner/Clinical Nurse Specialist, London Health Sciences Centre, South Street Hospital, London, Ontario, Canada, and is a member of the Michigan chapter of ANNA.