Rapid regression of calciphylaxis in a hemodialysis patient after intensive management of disturbance of calcium and phosphate metabolism: a case report with literature review

Mima, Yuuki; Wada, Yukihiro; Shikida, Yasuto; Hamada, Toma; Kanazawa, Nobuhiro; Iida, Ayana; Sugiyama, Motonori; Shibata, Takanori

doi:10.1186/s41100-019-0216-9

Cited by 2 publications

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References 31 publications

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“…Etelcalcetide is a novel intravenous calcimimetic that can be administered at the end of each HD session and has a longer elimination half-life than that of cinacalcet [27,28]. Therefore, administration of etelcalcetide is likely to be reliable and to improve the pill burden and management of calciphylaxis [29].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary management of calciphylaxis: a series of 5 patients at a single facility

et al. 2019

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Calciphylaxis is a rare and severe disease that manifests with painful skin ulceration and necrosis. Herein, we report five patients of hemodialysis patients with skin biopsy-proven calciphylaxis at a single facility. One patient had undergone parathyroidectomy (PTx) due to severe secondary hyperparathyroidism, four had been treated with vitamin D receptor activators, and two were on warfarin therapy. All patients had hyperphosphatemia, and one had hypercalcemia. The intact parathyroid hormone level at diagnosis was 2 pg/ml in the patient after PTx, while three patients were within the target range. The average period after diagnosis of calciphylaxis was 2 months. Skin lesions were present on the thighs and lower legs in two patients, and on the dorsum of the foot in one patient. In skin biopsy, calcification was found in the arteriolar media in four patients, and calcium (Ca) was deposited in the dermal lesion in one patient. All patients received local cures, surgical debridement, antibiotics to control infectious diseases, and strict control of serum Ca and phosphate. Calcimimetics were used in all patients except one who had undergone PTx one month before, sodium thiosulfate was used in 4 patients, and low Ca dialysate was used in three patients. The average follow-up period was 7.4 months. Four patients were cured, and one died due to infection. We suggest that multidisciplinary management for infectious diseases, surgical debridement, strict control of mineral and bone markers from the early stage, and elimination of risk factors may improve the course of calciphylaxis, which is a life-threatening disease.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary management of calciphylaxis: a series of 5 patients at a single facility

et al. 2019

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“…The precise pathogenesis of CUA is unknown and it is a multifactorial complex process displayed in Figure 1. [2][3][4] The gold standard for diagnosing CUA is a skin biopsy which carries risks including worsening of lesions and infections. 2 Therefore, CUA largely remains a clinical diagnosis in practice.…”

Section: Introductionmentioning

confidence: 99%

Characterization of Risk Factors for Calciphylaxis in Hemodialysis Patients in the Fraser Health Renal Program – A Matched Case-Control Retrospective Review

Jang

Yan

2022

Journal of Pharmacy Practice

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Introduction Calciphylaxis is a lethal and rare disease characterized by ischemic and necrotic skin lesions caused by vascular calcification of adipose tissue. There have been many risk factors analyzed in the literature; however, the pathogenesis of calciphylaxis is still not well understood and treatment options are limited due to the lack of interventional studies. Our objectives were to describe risk factors, prevalence, incidence, and outcomes for calciphylaxis in hemodialysis patients within the Fraser Health Renal Program. Methods This was a retrospective matched case-control study of hemodialysis patients within the Fraser Health Renal Program. Hemodialysis patients with calciphylaxis were matched to hemodialysis patients without calciphylaxis in a 1:2 ratio for age and sex from September 2, 2017 to July 3, 2020. Findings There was a total of 40 calciphylaxis cases matched to 80 controls. In the univariate analysis, peritoneal dialysis, higher body mass index, lower serum iron, lower transferrin saturation, sevelamer, cinacalcet, warfarin, iron (PO), and insulin were associated with increased risk of calciphylaxis. In the multivariate analysis, only peritoneal dialysis, serum iron, sevelamer, and warfarin were identified as significant and strong risk factors associated with calciphylaxis. A low prevalence of 1.9% and high mortality rate of 57.5% at 12 months was found for calciphylaxis cases. Discussion Significant risk factors associated with calciphylaxis were peritoneal dialysis, serum iron, sevelamer, and warfarin. Future studies should further investigate the impact of minimizing exposure to these risk factors to reduce calciphylaxis development.

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Rapid regression of calciphylaxis in a hemodialysis patient after intensive management of disturbance of calcium and phosphate metabolism: a case report with literature review

Cited by 2 publications

References 31 publications

Multidisciplinary management of calciphylaxis: a series of 5 patients at a single facility

Multidisciplinary management of calciphylaxis: a series of 5 patients at a single facility

Characterization of Risk Factors for Calciphylaxis in Hemodialysis Patients in the Fraser Health Renal Program – A Matched Case-Control Retrospective Review

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