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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Major lower limb amputation (MLLA) is a devastating yet preventable complication among diabetic hemodialysis (HD) patients. While monthly foot checks are standard in many private-sector dialysis units, this practice has not been routinely employed at Veterans Affairs (VA) dialysis units. This quality improvement (QI) project aimed to implement and assess the impact of a monthly intradialytic foot check protocol on MLLA incidence among diabetic HD patients at a VA dialysis unit and to identify associated risk factors.
In November 2023, we initiated a monthly foot check protocol at the James J. Peters VA dialysis unit, where physical assessments of the lower extremities were performed by dialysis nurses. We performed a pre-post analysis comparing MLLA incidence (January 2021–November 2023 vs. November 2023–2024) using two-proportion Z-tests and Cox proportional hazards models. Key covariates included demographics, medication use, dialysis duration, and relevant laboratory values. Associations between risk factors and the history of MLLA were evaluated using univariable and multivariable logistic regression analyses.
Pre-implementation, the incidence of MLLA due to critical limb ischemia was 3.41 per 100 patient-years (9 amputations). Post-implementation, no MLLAs occurred among the thirty-eight patients receiving monthly foot checks, while three patients who did not receive foot checks underwent MLLA (incidence: 9.40 per 100 patient-years). Routine foot checks were associated with a 100% reduction in MLLA (p=0.032), and multivariable Cox regression confirmed that routine foot checks significantly reduced the hazard of MLLA by 99.997% (HR=0.003; p<0.001).
Among seventy-one diabetic HD patients, eighteen had a history of MLLA. Univariable logistic regression analyses revealed that Hispanic ethnicity (OR = 5.258, p=0.008) and statin use (OR = 7.35, p=0.018) were positively associated with MLLA, whereas antiplatelet use (OR = 0.22, p=0.034) and higher albumin levels (OR = 0.22, p=0.003) were protective (Table 1).
Univariable regression analyses found a positive association between the history of MLLA and several laboratory markers, including URR, Beta Globulin 2, Lipoprotein(a), Triglyceride-Glucose Index, and ferritin. However, only Lipoprotein (a) and ferritin were significantly associated with MLLA within one year (Table 2).
Routine monthly foot checks in diabetic HD Veterans were associated with a statistically significant reduction in MLLA. The protocol was well-tolerated and received positive feedback from staff. This simple protocol, along with managing associated risk factors such as lipoprotein (a) levels, provides a promising strategy for improving patient outcomes in VA dialysis units.
