C10: The Renal Foot

Up to 40% of people with diabetes develop chronic kidney disease, and the two complications amplify each other. Dialysis is an independent risk factor for foot ulceration, with an odds ratio of about 4, and foot risk rises sharply once dialysis starts and stays high. Medial arterial calcification makes vessels incompressible, so the ankle-brachial index can read normal or high in a severely ischaemic foot. These patients are seen three times a week, yet their feet are among the least examined parts of them.

The module teaches toe pressures, the toe-brachial index and Doppler waveforms in place of the ankle reading, and a renal risk-amplification model covering arterial, microvascular, neuropathic, immune, haemodynamic, bone-mineral and organisational risk. It covers heel protection on the dialysis couch, pain during or after dialysis as a perfusion signal, quiet infection, renal dosing and contrast, recognising calciphylaxis, naming an owner for foot care, and carrying surveillance across the transition to transplant, which reduces but does not abolish risk.

Content is tiered at Foundation, Core and Advanced level, with two algorithms and three case vignettes. You receive the Teaching Document, the Evidence Base, the slide deck and a narrated video.