Evaluating the validity of subclassifying warfarin‐associated nonuremic calciphylaxis: a retrospective cohort study

Lehman, Julia S.; Chen, Tiffany; Lohse, Christine M.; el‐Azhary, Rokea A.

doi:10.1111/ijd.13884

Cited by 9 publications

(8 citation statements)

References 4 publications

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“…Patients with diabetes mellitus and cancer had a preference for calciphylaxis. Warfarin, as an anticoagulant commonly used in clinic, is a well-recognized potential precipitating factor of calciphylaxis (17,18). In this epidemiological investigation, there was found that it memorably increased the risk of calciphylaxis although only 8.33% of patients had a history of warfarin therapy.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Liu

Yang

et al. 2022

Front. Med.

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BackgroundCalciphylaxis is a grievous life-threatening vascular disease that commonly affects dialysis population. This is the first epidemiological survey of calciphylaxis initiated in China.MethodsIn the cross-sectional survey, a stratified sampling method was used to select 24 dialysis centers in Jiangsu Province. The participants were all adult patients in each center who had been on hemodialysis for more than 6 months. Calciphylaxis patients were uniformly diagnosed based on characteristic skin lesions and histopathological features.ResultsA total of 3,867 hemodialysis patients (average age of 55.33 ± 13.89 years; 61.81% of males) were included. Forty eight cases were diagnosed with calciphylaxis, and prevalence was 1.24%. Among calciphylaxis patients, 33 cases were male, and the average age and median dialysis duration were 53.85 ± 15.17 years and 84.00 (48.00, 138.75) months, respectively. Skin biopsy was performed in 70.83% of calciphylaxis patients, and positive rate was 64.71%. Meanwhile, the positive rate of bone scintigraphy in the diagnosis of calciphylaxis was 62.5%. The prevalence of hyperparathyroidism in case group was as high as 72.92% with longer duration, and 42.86% had undergone parathyroidectomy. Multivariate analysis indicated that increased BMI, prolonged dialysis duration, warfarin therapy, hyperparathyroidism, diabetes, tumors, low serum albumin and high serum alkaline phosphatase levels were high-risk factors for calciphylaxis.ConclusionsThe prevalence of calciphylaxis in Chinese hemodialysis patients was 1.24% according to regional epidemiological survey, but its actual prevalence would be presumably far beyond present data. It's urgent to improve clinical understanding of calciphylaxis, and multifaceted diagnostic methods should be applied for early screening.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Liu

Yang

et al. 2022

Front. Med.

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“…Warfarin-associated calciphylaxis is a crucial clinical subgroup with independent pathophysiologic features [45]. Warfarin can not only promote vascular calcification by inhibiting the vitamin K-dependent matrix Gla protein which prevents calcium deposition in arteries, but also directly increase thrombosis through the coagulation pathway [45,46]. And the latest research observed that the ESKD undergoing hemodialysis is a deficiency state of vitamin K [47].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for calciphylaxis in Chinese hemodialysis patients: a matched case-control study

et al. 2021

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Introduction: Calciphylaxis is a rare but potentially fatal disease commonly occurred in dialysis patients. Despite some previous studies on risk factors for calciphylaxis, there is still a lack of data from Chinese population. Methods: The retrospective matched case-control study about calciphylaxis was performed in Zhongda Hospital affiliated to Southeast University. The case group involved 20 hemodialysis patients who were newly diagnosed with calciphylaxis from October 2017 to December 2018. The 40 noncalciphylaxis patients undergoing dialysis with the same age and duration of dialysis were randomly selected as controls. Results: Most of calciphylaxis patients were male and elderly, while overweight people were more susceptible to the disease. Although incidence of secondary hyperparathyroidism was higher in calciphylaxis patients, the differences in duration of elevated serum intact parathyroid hormone (iPTH) and its highest value did not reach statistical significance compared with controls. No significant difference in warfarin therapy was discernible between two groups. The univariate regression analysis indicated that male, score of use of activated vitamin D and its analogues, corrected serum calcium level, serum phosphate, Ca Â P product, iPTH, albumin, and alkaline phosphatase (ALP) level were significantly associated with calciphylaxis. Elevated levels of serum phosphate (OR 4.584, p ¼ 0.027) and ALP (OR 1.179, p ¼ 0.036), decreased level of serum albumin (OR 1.330, p ¼ 0.013) were independent risk factors after multivariate analysis. Conclusion: This is the first report of risk factors associated with calciphylaxis in China. Increased levels of serum phosphate and ALP, decreased level of serum albumin were vital high-risk factors for calciphylaxis in Chinese hemodialysis population.

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“…In contrast, some studies have revealed that ESRD patients with mechanical valves more commonly present with bleeding or thromboembolic events than structural deterioration of bioprosthetic valves (17,24,27). Patients with ESRD receiving mechanical valve replacement require warfarin for stroke prevention, which is usually associated with a higher risk of bleeding event, metastatic calcification, and catastrophic calciphylaxis (15,16). The aforementioned complications could increase the periprocedural mortality, as shown in the present findings.…”

Section: Long-term Outcome Of Mechanical and Bioprosthetic Valve Replacement Among Esrd Patientsmentioning

confidence: 49%

“…In contrast, patients with ESRD receiving anticoagulants are at higher risk of bleeding, (13,14) metastatic calcification, and even calciphylaxis (15,16). In addition, ESRD patients have a short life expectancy.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study

Chen

Chung

et al. 2021

Front. Cardiovasc. Med.

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Background: Valve replacement is associated with worse outcomes in individuals who have end-stage renal disease (ESRD) and require a long-term renal replacement therapy. Prosthetic valve selection in patients with ESRD has remained controversial.Objective: We aimed to investigate long-term outcomes of mechanical and bioprosthetic valve replacement in individuals with ESRD.Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,202 patients, including 912 ESRD and 9,290 non-ESRD patients, were selected after a 1:1 propensity-score matching based on the type of prosthetic valve used. The long-term mortality outcomes were then analyzed.Results: During a median follow-up period of 59.6 months, the Kaplan–Meier survival analysis revealed that ESRD patients who underwent mechanical valve replacement had higher rates of all-cause mortality and CV deaths than those who underwent bioprosthetic valve replacement (Log-rank test, p = 0.03 and 0.02, respectively). Multivariable regression analyses demonstrated that ESRD patients who underwent bioprosthetic valve replacement had lower rates of all-cause mortality (p < 0.001, hazard ratio: 0.88, 95% confidence interval: 0.82–0.93) and cardiovascular (CV) death (p < 0.001, hazard ratio: 0.83, 95% confidence interval: 0.76–0.90) than those who had mechanical valve replacement.Conclusion: Bioprosthetic valve replacement is significantly associated with lower rates of all-cause mortality and CV death in the ESRD population.

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Evaluating the validity of subclassifying warfarin‐associated nonuremic calciphylaxis: a retrospective cohort study

Cited by 9 publications

References 4 publications

Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Risk factors for calciphylaxis in Chinese hemodialysis patients: a matched case-control study

Long-Term Outcomes of Bioprosthetic or Mechanical Valve Replacement in End-Stage Renal Disease: A Nationwide Population-Based Retrospective Study

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