A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies

Don, Burl R.; Chin, Andrew I.

doi:10.5414/cnp59463

Cited by 64 publications

(58 citation statements)

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“…14 Hyperbaric oxygen therapy involves breathing 100% oxygen at a pressure of 2-3 times atmospheric pressure with many demonstrable effects in wound healing including reversal of wound hypoxia, upwards to level of at least 400 mmHg. 15 In addition to counteracting local wound hypoxia, hyperbaric oxygen also promotes vasoconstriction resulting in decreased edema, inhibits neutrophil adhesion and subsequent inflammatory cascade, increases neutrophil bactericidal activity and augments the bacteriostatic or bactericidal effects of certain antibiotics against anaerobic micro-organisms resulting in better control of wound infections.…”

Section: Discussionmentioning

confidence: 99%

Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy

McCulloch

Wojcik

Heyboer

2015

Journal of the American College of Clinical Wound Specialists

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Calcific uremic arteriolopathy, also known as calciphylaxis, is a rare syndrome of small vessel calcification of unknown etiology causing painful, violaceous skin lesions that progress to form chronic non-healing ulcers and gangrene. Hyperbaric oxygen therapy (HBOT) can be used as adjunctive therapy in the treatment of these ulcers. However, due to paucity of cases, there is limited data on the clinical benefit of HBOT and identifying factors associated with healing. The purpose of this study was to determine patient outcomes and factors associated with healing in patients with calciphylaxis undergoing HBOT. A retrospective chart review was completed on patients who were diagnosed with calciphylaxis and had hyperbaric medicine consultation between May 2012 and January 2016. Clinical outcomes, demographics, risk factors, laboratory values, wound distribution, and HBOT profiles were collected and analyzed. We identified 8 patients. Out of 8 patients consulted for calciphylaxis, five were consented and underwent HBOT (2 males and 3 females). All had coexisting ESRD and Diabetes. All males were able to tolerate being in the chamber and received therapeutic treatments (at least 20 HBOT) with complete resolution of ulcers. HBOT was discontinued in one female due to an inconsistent biopsy report and two others due to death secondary to septic shock or respiratory arrest and severe uremia. Calciphylaxis is a devastating disease with a high mortality rate. Our results demonstrated a positive response to HBOT especially when receiving at least 20 treatments. A majority of calciphylaxis cases are females and indeed female gender has been cited as a risk factor for this disease. However, current literature has not conferred a relationship between gender nor the number of HBOT received and outcomes. Our results showed that males had a more favorable outcome provided they received at least twenty HBOT. Further prospective studies are needed to elucidate these outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy

McCulloch

Wojcik

Heyboer

2015

Journal of the American College of Clinical Wound Specialists

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“…Avoidance of a positive calcium balance and preventing the development of hypercalcemia should be a high priority (Table 2). Limited clinical data are available suggesting that lowering calcium intake improves CUA (27,34). Thus, discontinuation of calcium-based phosphate binders, adjustment of hemodialysis or peritoneal dialysis dialysate, and minimizing the use of VDRAs should be considered as initial therapeutic steps.…”

Section: Managementmentioning

confidence: 99%

“…However, most agree that debridement should be kept to a minimum because of poor wound healing with secondary infections and extension of the lesions (27). It is important to maintain a sterile environment with local wound care that should include gentle wound debridement while avoiding deep or wide surgical debridement and skin grafting.…”

Section: Managementmentioning

confidence: 99%

“…It is important to maintain a sterile environment with local wound care that should include gentle wound debridement while avoiding deep or wide surgical debridement and skin grafting. Appropriate sterile dressings should provide a moist environment while removing excessive exudates and should be easy to apply and remove in order to reduce surrounding skin trauma (4,27,28).…”

Section: Managementmentioning

confidence: 99%

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Painful Skin Ulcers in a Hemodialysis Patient

Sprague

2014

Clinical Journal of the American Society of Nephrology

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SummaryCalciphylaxis, also referred to as calcific uremic arteriolopathy, is a relatively rare but well described syndrome that occurs most commonly in patients with late stage CKD. It is characterized by very painful placques or subcutaneous nodules and violaceous, mottled skin lesions that may progress to nonhealing ulcers, tissue necrosis, and gangrene with a 1-year mortality rate >50%. The pathogenesis of calciphylaxis is poorly understood. Risk factors include female sex, obesity, hyperphosphatemia, hypercalcemia, hyperparathyroidism, longer dialysis vintage, hypercoagulable states, and use of calcium-containing phosphate binders and warfarin. Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Therapy is generally focused on correcting disturbances of calcium, phosphorus, and parathyroid hormone metabolism. Additional therapy focuses on decreasing inflammation and on dissolution of tissue calcium deposits with sodium thiosulfate and/or bisphosphonates. Successful treatment generally results in improvement of pain and healing of the lesions within 2-4 weeks, but the disorder generally takes many months to completely resolve.Clin J Am Soc Nephrol 9: 166-173, 2014. doi: 10.2215/CJN.00320113Case Description Abhijit Naik, MD (Renal Fellow). A 54-year-old white man was referred from an outside dialysis clinic for evaluation of necrotic skin lesions. He had a 10-year history of diabetes and hypertension, with ESRD secondary to diabetes. His history was also significant for coronary artery disease, with two prior myocardial infarctions and atrial fibrillation. He had been undergoing thrice-weekly hemodialysis for 2 years with a Kt/V between 1.3-1.4. Three months before presentation he noticed several small firm and very painful nodules on both anterior thighs. He stated that after several weeks the lesions became much larger, black, and spread to the lateral thighs and buttocks. He was treated with mupirocin ointment and a vascular evaluation revealed normal blood flow in his legs. Aside from these painful lesions, he stated that he generally felt "ok." Dialysis had been proceeding without problems. He denied chest pain, dyspnea, abdominal pain, or any gastrointestinal complaints. Review of systems was otherwise unremarkable. He never smoked and drank alcohol very infrequently. Medications included aspirin, amiodarone, simvastatin, famotidine, glipizide, clopidogrel, sevelamer carbonate, hydrocodone, and gabapentin. He had no known allergies.On examination his vital signs were as follows: temperature, 98.8°F; heart rate, 80 beats per minute; BP, 94/60 mmHg, with no orthostatic changes; and respiratory rate, 20 breaths per minute. His BP was generally low, with systolic BP averaging between 90 and 100 mmHg. He was an ill appearing male in mild distress from extremity pain. His lungs were clear and a cardiovascular examination revealed a regular rate and rhythm with a 2/6 holosystolic murmur. His abdomen had normal bowel sounds and was mildly distended with some asc...

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“…Although the etiology of calciphylaxis is probably multifactorial, it seems plausible from what we understand of its biochemistry and physiology that vitamin K 2 deficiency may play a central role in the pathogenesis of this condition. In addition to local care of skin ulcerations, careful monitoring of calcium and phosphate levels in dialysis patients (16), and intravenous sodium thiosulphate (17)(18)(19), vitamin K 2 may prove to be an effective, nontoxic therapy for this devastating disease.…”

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confidence: 99%

Potential treatment of calciphylaxis with vitamin K₂: Comment on the article by Jacobs‐Kosmin and DeHoratius

Levy¹

2007

Arthritis & Rheumatism

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A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies

Cited by 64 publications

References 0 publications

Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy

Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy

Painful Skin Ulcers in a Hemodialysis Patient

Potential treatment of calciphylaxis with vitamin K₂: Comment on the article by Jacobs‐Kosmin and DeHoratius

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A strategy for the treatment of calcific uremic arteriolopathy (calciphylaxis) employing a combination of therapies

Cited by 64 publications

References 0 publications

Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy

Patient Outcomes and Factors Associated with Healing in Calciphylaxis Patients Undergoing Adjunctive Hyperbaric Oxygen Therapy

Painful Skin Ulcers in a Hemodialysis Patient

Potential treatment of calciphylaxis with vitamin K2: Comment on the article by Jacobs‐Kosmin and DeHoratius

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Potential treatment of calciphylaxis with vitamin K₂: Comment on the article by Jacobs‐Kosmin and DeHoratius