Research Article| Volume 194, 110160, December 2022

Biomarkers of chronic kidney disease-mineral bone disorder (CKD-MBD) in the diabetic foot: A medical record review

Published:November 17, 2022DOI:


      • The diabetic foot is an overlooked target of CKD–MBD syndrome.
      • Progressive CKD-MBD in the diabetic foot leads to increased risk for minor foot amputation.
      • Foot radiography and serum markers may be effective screening tools for CKD-MBD in patients with diabetesmellitus.
      • Findings from this novel investigation may alert clinicians in helping to reduce nontraumatic lower extremity amputation.



      Determine the prevalence and relative risk of having single and combinations of biomarkers of chronic kidney disease-mineral bone disorder (CKD-MBD) syndrome in the diabetic foot from an electronic medical record (EMR) review.


      Review of 152 patients with one foot radiograph and diagnoses of both diabetes mellitus (DM) and chronic kidney disease (CKD) stages 1–5. Presence/absence of peripheral neuropathy (PN), targeted serum markers, and both pedal vessel calcification (PVC) and buckling ratio (BR) of 2nd and 5th metatarsals from radiographs were recorded. Prevalence of single and combinations of foot biomarkers are reported as count and percentage. Risk ratios (RR) with 95% confidence intervals (95% CI) were calculated to assess risk of foot biomarkers in each stage of CKD-MBD.


      Prevalence and RR of PVC, PN, and BR ≥ 3.5 biomarkers, both single and in combination, all increase with progression of CKD. The RR increases to 9.6 (95 % CI: 3, 26; p < 0.001) when all 3 biomarkers present in stage 5.


      PVC, PN, and BR ≥ 3.5 are prognostic biomarkers of CKD–MBD syndrome in the diabetic foot. Recognition of these foot biomarkers may allow earlier interventions to help reduce nontraumatic lower extremity amputation in individuals with diabetic CKD-MBD.


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