Date of Award


Document Type

Open Access Dissertation


College of Nursing


Nursing Practice

First Advisor

Joan Culley


ABSTRACT In 2010 the number of patients requiring renal replacement therapy in the United States increased by 1% to 593,086. This number was comprised of 593,086 in center hemodialysis patients, 179,361 functioning kidney transplants, and 29,773 peritoneal dialysis patients.

A principal difficulty in the end stage renal disease (ESRD) population is lower extremity amputation from vascular complications and nonhealing wounds. The incidence of nontraumatic lower extremity amputation among the end stage renal disease population in the United States is ten times higher when compared to the general public. Mortality rates for ESRD patients following amputation are elevated with less than 50% surviving two years postoperatively. Increased vascular complications force many amputees to undergo revisions to an amputated site, revascularization, or additional limb removal. Despite the increased mortality risk there is no lower extremity assessment guideline for ESRD patients. The National Kidney Foundation does not require assessments to be performed even though early detection and prevention may potentially alleviate the need for amputation.

The purpose of this project was to analyze and synthesize current research regarding amputation risks in the ESRD population and devise a lower extremity assessment tool that can easily be performed in the hemodialysis unit. Following staff education, the quick assessment tool was placed into use at Upstate Dialysis in Greenville, SC. The dialysis nurses performed lower extremity assessments based on protocol for a period of three months on all dialysis patients with diabetes or over the age of 65 years. Irregularities were noted on the assessment tool and referrals were made to wound management, vascular surgery, and podiatry as needed. Accurate numbers of referrals were maintained for statistical analysis. Findings revealed eleven new referrals were made to specialists in the three month period. These findings resulted in early recognition of complications including the need for a great toe amputation from osteomyelitis, a revascularization, and nine referrals for follow up care for potential complications. Recommendations from this research include a standardized lower extremity tool for all hemodialysis patients, continued education for the staff and patients to identify potential lower extremity complications early, and ongoing research to decrease mortality risks in this population from vascular complications.


© 2013, Karen Robertson

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