Calciphylaxis in a dialysis patient successfully treated with high-dose vitamin K supplementation

Christiadi, Daniel; Singer, Richard

doi:10.1093/ckj/sfx126

Cited by 17 publications

(11 citation statements)

References 5 publications

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“…The management of CUA remains problematic as clinicians have largely relied on case series and small uncontrolled studies for guidance. Several agents such as sodium thiosulphate, calcimimetics [ 5 ], bisphosphonates [ 6 ] and vitamin K have been identified as showing promise in small studies, although real benefit of these agents in isolation is still under debate [ 7 – 9 ]. Country-based registries and studies have been a major resource in providing data on the natural history and outcomes of CUA [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Calciphylaxis in end-stage kidney disease: outcome data from the United Kingdom Calciphylaxis Study

et al. 2021

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Background and aims Calciphylaxis is a rare condition associated with very high mortality in patients with end-stage kidney disease. Data from country-based registries have been an invaluable resource for a better understanding of the natural history and management for this condition. This study aimed to investigate the current management strategies and outcomes of patients enrolled in the United Kingdom Calciphylaxis study (UKCS). Methods The study was conducted on 89 patients registered in the UKCS since 2012. The initial analysis included a description of the baseline characteristics, management strategies and outcomes on follow-up until May 2020. Further analysis included a comparison of the mortality outcome of the UKCS patients who were receiving haemodialysis with a propensity score matched cohort of haemodialysis patients from the Chronic Renal Insufficiency Standards Implementation Study- Haemodialysis (CRISIS-HD). Results Median age of the cohort was 59 years, with a predominance of females (61%) and Caucasian (95%) ethnicity. About 54% of the patients were diabetic and 70% were receiving haemodialysis at study entry. The skin lesions were mostly distributed in the lower extremities (48%). Sodium thiosulphate and calcimimetic were the most widely used management strategies. The mortality rate was 72 deaths per hundred patient-years (50 deaths observed in 69.5 patient years). Complete wound healing was noted in 17% and bacteraemia was reported in 26% of patients. In a comparative analysis of the matched haemodialysis patients, the presence of calciphylaxis in 62 patients showed a strong association with all-cause mortality (HR 6.96; p < 0.001), with annual mortality 67% versus 10.2% in haemodialysis patients without calciphylaxis. Conclusions This UK wide study strengthens the evidence that calciphylaxis is a strong and independent risk factor associated with all-cause mortality; no significant benefit was shown with any individual treatment modality. Until further evidence becomes available, a multifaceted approach would be the appropriate treatment strategy in the management of this extremely serious condition. Graphic abstract

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Section: Introductionmentioning

confidence: 99%

Calciphylaxis in end-stage kidney disease: outcome data from the United Kingdom Calciphylaxis Study

et al. 2021

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“…In a recent meta-analysis of STS use in uremic calciphylaxis, improvement in lesions was observed in 70.1% of patients [ 17 ]. Another agent being used for treatment is vitamin K, which has been shown to reduce vascular calcification in animal models [ 18 ]. A newer agent, called SNF472 (intravenous myo-inositol hexaphosphate), blocks the formation of hydroxyapatite and has been assessed recently for treatment in calciphylaxis [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Non-Uremic Calciphylaxis: An Unexpected Complication With Recombinant Human Parathyroid Hormone

DeClue¹,

Chinnakotla²,

Gardner³

2021

Cureus

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Calciphylaxis is a rare syndrome of calcific microvascular occlusion, whereas non-uremic calciphylaxis (NUC) is a subset of this disease in which renal impairment is not observed. Recombinant human parathyroid hormone (rhPTH) (1-84) is a medication approved for the management of hypocalcemia in patients with hypoparathyroidism. We present a case report of a 38-year-old woman with postoperative hypoparathyroidism treated with rhPTH who subsequently developed calciphylactic lesions on her abdomen. Multidisciplinary interventions included intravenous and intralesional sodium thiosulfate therapy, laboratory monitoring, dermatological wound care, and pain management. Calciphylaxis can rarely be precipitated by rhPTH due to its effect on calcium and phosphorus balance even in the setting of normal renal function. The use of calcium and calcitriol supplementation, complicated by factors such as female sex and obesity, may have contributed in this patient's case. Hence, regular follow-up with tapering off of calcium and calcitriol supplementation is important in patients receiving rhPTH.

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“…The management of this disease should be multi‐targeted but it is difficult to define a standard protocol in the absence of randomized controlled trials . Treatment consists first of all in the correction of modifiable risk factors by increasing the dialysis dose (daily dialysis), by improving the control of calcium and phosphate balance (avoiding oral calcium supplements, initiating phosphate binders and bisphosphonates), by reducing hyperparathyroidism (parathyroidectomy, calcimimetics) and by stopping vitamin K antagonists when possible . Recently, it has been proposed to relay vitamin K antagonists by direct anticoagulants, such as apixaban .…”

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confidence: 99%

“…10,11 Treatment consists first of all in the correction of modifiable risk factors by increasing the dialysis dose (daily dialysis), by improving the control of calcium and phosphate balance (avoiding oral calcium supplements, initiating phosphate binders and bisphosphonates 12 ), by reducing hyperparathyroidism (parathyroidectomy, calcimimetics 8 ) and by stopping vitamin K antagonists when possible. 13 Recently, it has been proposed to relay vitamin K antagonists by direct anticoagulants, such as apixaban. 14 The use of sodium thiosulfate is common, mainly systemically, but local use has also been described.…”

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confidence: 99%

Rheopheresis: A new therapeutic approach in severe calciphylaxis

Robert¹,

Lionet

Bataille³

et al. 2019

Nephrology

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Aim Uremic calciphylaxis, also called calcific uraemic arteriolopathy (CUA), is a rare disease with a poor prognosis (mortality between 45% and 80%). Treatment is currently not standardized, and is based mainly on risk factor control, often with administration of sodium thiosulfate. We report the use of rheopheresis, a double filtration apheresis technique, specifically designed to improve blood rheology and tissue perfusion, as adjunctive therapy in eight patients with severe CUA. Methods We retrospectively analysed eight cases of severe CUA treated by rheopheresis after failure of conventional measures, including administration of sodium thiosulfate and discontinuation of vitamin K antagonists. Results Of the patients, there were 5 (63%) women, the median age was 69 (63.9‐73) years. Four (50%) patients had biopsy‐proven CUA. At diagnosis, the median dialysis vintage was 35 (3.9‐42) months; five (63%) patients were anuric. Weekly median dialysis duration and dose were 12 (12‐12.75) hours and 1.19 (1.13‐1.48) Kt/V per dialysis session, respectively. Median time from CUA onset to first rheopheresis therapy was 26 (3.2‐68) days. Patients started with 2‐3 weekly sessions, coupled with haemodialysis. Complete remission was obtained in five patients (66%) after 25 (19‐39) sessions over a duration of 119 (114‐196) days. Three patients died, two of which resulted from an infectious complication related to CUA. Conclusion Rheopheresis is a promising approach, with a good safety profile, for the treatment of CUA. A prospective study with a larger population, would clarify its place in the therapeutic armamentarium.

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Calciphylaxis in a dialysis patient successfully treated with high-dose vitamin K supplementation

Cited by 17 publications

References 5 publications

Calciphylaxis in end-stage kidney disease: outcome data from the United Kingdom Calciphylaxis Study

Calciphylaxis in end-stage kidney disease: outcome data from the United Kingdom Calciphylaxis Study

Non-Uremic Calciphylaxis: An Unexpected Complication With Recombinant Human Parathyroid Hormone

Rheopheresis: A new therapeutic approach in severe calciphylaxis

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