Nonuraemic calciphylaxis: response to treatment with pamidronate and negative pressure therapy

Lorriaux, A; Chaby, G.; Dhaille, F.; Dadban, A.; Arnault, Jean‐Philippe; Dhillies, A. S.; Lombart, F.; Chatelain, Denis; Lok, C.

doi:10.1111/ced.12505

Cited by 11 publications

(15 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although wound care is emphasized in the literature as a crucial aspect of CUA treatment, controversy still remains regarding how wounds are best cared for and whether surgical debridement should be part of routine CUA care [ 25 ]. This controversy stems from the concern that aggressive debridement could cause local injury that could worsen CUA lesions.…”

Section: Discussionmentioning

confidence: 99%

Multi-intervention management of calcific uremic arteriolopathy in 24 patients

Harris

Kiaii

Lau

et al. 2018

Clinical Kidney Journal

View full text Add to dashboard Cite

BackgroundCalcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a rare but life-threatening condition predominately occurring in patients with end-stage renal disease on dialysis. In the absence of randomized clinical trials to guide management, clinicians must rely on observational data. We have previously reported the outcomes of our multi-intervention management in seven patients and now present a larger series of patients with extended follow-up.MethodsWe performed a retrospective analysis of all patients diagnosed with CUA at a single academic center between 2008 and 2017. We identified 24 patients including 13 hemodialysis, 8 peritoneal dialysis and 3 predialysis Stage 5 chronic kidney disease patients.ResultsMean age at diagnosis was 60.5 years (range 35–83) and mean follow-up 30.5 months (range <1–99). Patients were predominately female (71%) and Caucasian (83%) with diabetes mellitus diagnosed in 16 of 24 patients. Fifteen of 24 patients had ulcerating lesions suggestive of advanced disease and 20 of 24 had extensive involvement (bilateral disease or lesion size >5 cm). Treatment consisted of intensive hemodialysis (>20 h per week), sodium thiosulfate, wound care, analgesics and discontinuation of trigger medications including warfarin. Hyperbaric oxygen, cinacalcet, bisphosphonates and vitamin K were used in some cases. Overall 1 year mortality was 41% (9/22) and overall mortality at the end of follow-up was 64% (14/24). Cause of death was felt to be attributable to CUA in only four cases (16.7%). Complete or partial resolution of lesions occurred in 17 of 24 patients. One patient had recurrence of CUA 20 months after initial diagnosis.ConclusionsAlthough mortality remains high in this group, direct CUA-attributable mortality is lower than historic reports. We conclude that a multi-intervention approach can be successful in treating a group of patients with severe CUA lesions.

show abstract

Section: Discussionmentioning

confidence: 99%

Multi-intervention management of calcific uremic arteriolopathy in 24 patients

Harris

Kiaii

Lau

et al. 2018

Clinical Kidney Journal

View full text Add to dashboard Cite

show abstract

“…This case represents NUC wounds that were successfully treated with pamidronate infusions. To our knowledge, only two other case series reported the successful treatment of NUC with pamidronate, which were performed in Europe . The first reported case was in Germany by Schliep et al; he was able to treat calciphylaxis of unknown origin with 6 pamidronate infusion and a repeated skin biopsy showed that the arterial calcification had vanished .…”

Section: Discussionmentioning

confidence: 99%

“…The second reported case was in France by Lorriaux et al In that case series, both patients were initially treated with sodium thiosulphate, but that was discontinued because of side effects. They were then started on pamidronate disodium 30 mg infusions every 2 weeks, and a marked improvement was noted after eight infusions …”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, only two other case series reported the successful treatment of NUC with pamidronate, which were performed in Europe. 17,18 The first reported case was in Germany by Schliep et al; he was able to treat calciphylaxis of unknown origin with 6 pamidronate infusion and a repeated skin biopsy showed that the arterial calcification had vanished. 17 The second reported case was in France by Lorriaux et al 18 In that case series, both patients were initially treated with sodium thiosulphate, but that was discontinued because of side effects.…”

Section: Discussionmentioning

confidence: 99%

“…They were then started on pamidronate disodium 30 mg infusions every 2 weeks, and a marked improvement was noted after eight infusions. 18 Most of the current treatment modalities for NUC are modelled from CUA treatment. Hammadah et al reported a case of successful resolution of NUC in a patient with acral gangrene with treatment using sodium thiosulphate.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Non‐uraemic calciphylaxis successfully treated with pamidronate infusion

Truong

Riedhammer

Zinszer

2018

International Wound Journal

View full text Add to dashboard Cite

Calciphylaxis is a rare and potentially fatal disease that affects the subcutaneous layer of the skin. It is a calcific vasculopathy induced by a systemic process that causes occlusion of small blood vessels. The mortality rate for individuals diagnosed with calciphylaxis is estimated between 52% and 81% with sepsis being the leading cause of death. Uraemic calciphylaxis and its known effective treatments are well documented in the literature. Unfortunately, there is no known effective treatment for non‐uraemic calciphylaxis. Most of the current treatments for non‐uraemic calciphylaxis are derived from uraemic calciphylaxis treatment protocols. We report a case of a 75‐year‐old female with calciphylaxis on the right lower extremity who was successfully treated with four pamidronate infusions in addition to local wound care. This case represents a non‐uraemic calciphylaxis wound successfully treated with pamidronate infusions and standard wound care, and suggests that IV pamidronate can be an effective treatment option.

show abstract

Sodium thiosulfate

2015

Reactions Weekly

View full text Add to dashboard Cite

Nonuraemic calciphylaxis: response to treatment with pamidronate and negative pressure therapy

Cited by 11 publications

References 9 publications

Multi-intervention management of calcific uremic arteriolopathy in 24 patients

Multi-intervention management of calcific uremic arteriolopathy in 24 patients

Non‐uraemic calciphylaxis successfully treated with pamidronate infusion

Sodium thiosulfate

Contact Info

Product

Resources

About