Pathophysiology of Wound Development and Chronicity in Renal Disease: A Narrative Review Article Swipe
Kirtana Sandepudi
,
Krish V. Shah
,
Bradley A. Melnick
,
Rui Li
,
Kelly Ho
,
Madeline J. O’Connor
,
Robert D. Galiano
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1111/iwj.70713
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.1111/iwj.70713
Renal disease, including chronic kidney disease (CKD) and end‐stage renal disease (ESRD), has a profound impact on wound healing. Multiple studies have demonstrated that renal disease leads to an increased risk of diabetic foot ulcers, the formation of unique wounds like calciphylaxis, slower wound healing and a higher risk of amputation. This review details the interrelated mechanisms by which renal disease impacts wound healing. Motor and sensory neuropathies contribute to wound formation via foot deformities and decreased sensation. Neuropathies also decrease neuropeptide release, impairing angiogenesis and inflammatory regulation. Accumulation of uremic toxins in renal disease leads to vessel wall calcification, impairing blood supply and predisposing patients to calciphylaxis. Vitamin and mineral deficiencies lead to impaired clotting, development of a chronic inflammatory state and decreased collagen production. Renal disease and its comorbidities are also associated with immune dysregulation, increasing the risk of wound infections and promoting the persistence of pro‐inflammatory macrophages. While hypoxia‐inducible factor‐1α (HIF‐1α) promotes angiogenesis under hypoxic conditions in normal wound healing, oxidative stress and chronic hypoxia in renal disease generate an environment that compromises the activity of HIF‐1α. Inadequate erythropoietin response to hypoxia also leads to anaemia, further impairing oxygen delivery to wound sites. Clinically, these factors result in increased 10‐year mortality for patients with DFU and CKD compared to those with DFU alone, both with and without amputation. We must utilise our understanding of the pathophysiology of impaired wound healing in renal disease to target preventative measures, optimise treatment and improve overall outcomes.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1111/iwj.70713
- https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/iwj.70713
- OA Status
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- Cited By
- 1
- References
- 79
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4411746023Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1111/iwj.70713Digital Object Identifier
- Title
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Pathophysiology of Wound Development and Chronicity in Renal Disease: A Narrative ReviewWork title
- Type
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reviewOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-06-28Full publication date if available
- Authors
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Kirtana Sandepudi, Krish V. Shah, Bradley A. Melnick, Rui Li, Kelly Ho, Madeline J. O’Connor, Robert D. GalianoList of authors in order
- Landing page
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https://doi.org/10.1111/iwj.70713Publisher landing page
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/iwj.70713Direct link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/iwj.70713Direct OA link when available
- Concepts
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Medicine, Wound healing, Kidney disease, Calciphylaxis, Disease, Hypoxia (environmental), Inflammation, Angiogenesis, Renal replacement therapy, Internal medicine, Surgery, Organic chemistry, Chemistry, OxygenTop concepts (fields/topics) attached by OpenAlex
- Cited by
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1Total citation count in OpenAlex
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2025: 1Per-year citation counts (last 5 years)
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79Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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