Risk factors and mortality associated with calciphylaxis in end-stage renal disease

Mazhar, Areej; Johnson, Richard J.; Gillen, Daniel L.; Stivelman, John C.; Ryan, Michael J.; Davis, Connie L.; Stehman‐Breen, Catherine

doi:10.1046/j.1523-1755.2001.00803.x

Cited by 292 publications

(270 citation statements)

References 19 publications

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“…The 1-year mortality rate is lower compared with historical published data in patients with CUA not treated with STS, in whom the 1-year mortality rate has been reported at 55% (25). As shown in Figure 3, surveyed patients had lower overall mortality than nonsurveyed patients: The unadjusted HR was 0.51 (95% CI, 0.29-0.90).…”

Section: Outcome Of Cuamentioning

confidence: 75%

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Nigwekar

Brunelli

Meade

et al. 2013

Clinical Journal of the American Society of Nephrology

186

136

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SummaryBackground and objective Calcific uremic arteriolopathy (CUA) is an often fatal condition with no effective treatment. Multiple case reports and case series have described intravenous sodium thiosulfate (STS) administration in CUA, but no studies have systematically evaluated this treatment.Design, setting, participants, & measurements This study included 172 patients undergoing maintenance hemodialysis who had CUA and were treated with STS between August 2006 and June 2009 at Fresenius Medical Care North America. Of these, 85% completed STS therapy. Clinical, laboratory, and mortality data were abstracted from clinical information systems. Responses to survey questionnaires sent to treating physicians regarding patient-level outcomes were available for 53 patients. Effect on CUA lesions and mortality were summarized as CUA outcomes. Relevant laboratory measures, weight (using pairwise comparisons of values before, during, and after STS), and adverse events were summarized as safety parameters.Results Mean age of the cohort was 55 years, and 74% of patients were women. Median STS dose was 25 g, and median number of doses was 38. Among surveyed patients, CUA completely resolved in 26.4%, markedly improved in 18.9%, improved in 28.3%, and did not improve in 5.7%; in the remaining patients (20.8%), the response was unknown. One-year mortality in patients treated with STS was 35%. Adverse events, laboratory abnormalities, and weight-related changes were mild. Significant reductions in serum phosphorous (P=0.02) and parathyroid hormone (P=0.01) were noted during STS treatment in patients who completed the therapy.Conclusions Although conclusive evidence regarding its efficacy is lacking, a majority of patients who received STS demonstrated clinical improvement in this study.

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Section: Outcome Of Cuamentioning

confidence: 75%

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Nigwekar

Brunelli

Meade

et al. 2013

Clinical Journal of the American Society of Nephrology

186

136

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“…É caracterizada por nódulos subcutâneos dolorosos, que podem ulcerar, cuja biópsia mostra necrose cutânea e deposição de proteínas da matriz do osso em pequenos vasos (20,34). Em pacientes com IRC, a presença de calcifilaxia aumenta em oito vezes o risco de morte, e a mortalidade chega a 80% dos casos, geralmente por infecção secundária das lesões (34,35).…”

Section: Discussionunclassified

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

Lacativa¹,

Filho

Gonçalves³

et al. 2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 6 Dezembro 2003 644 RESUMOO hiperparatireoidismo é uma manifestação comum na insuficiência renal crônica (IRC), com alta morbi-mortalidade e difícil manejo clínico. As indicações clássicas da paratireoidectomia são: hipercalcemia persistente, principalmente após transplante renal, prurido intratável, fraturas patológicas, dor óssea refratária ao tratamento medicamentoso e calcificação metastática. Infelizmente, esta última não responde à paratireoidectomia e a calcificação dos vasos está relacionada ao aumento da mortalidade. Assim, novos critérios para indicação mais precoce de paratireoidectomia são necessários. Níveis séricos de PTH maiores que 10 vezes o limite da normalidade, apesar da adequada reposição de cálcio e calcitriol, produto cálcio x fósforo maior que 70(mg/dl) 2 , tumor marrom quando é urgente a regressão da massa, artrite e/ou periartrite incapacitantes e ruptura de tendões estão entre outras indicações a serem consideradas. Alguns cuidados são necessários para excluir doenças ósseas concomitantes, como amiloidose e intoxicação por alumínio. Esta revisão visa a orientar os endocrinologistas sobre as indicações e melhor momento de realizar paratireoidectomia no hiperparatireoidismo da IRC. Hyperparathyroidism is a common complication of end-stage renal insufficiency, with a high morbi-mortality and difficult medical control. Classical indications for parathyroidectomy are: persistent hypercalcemia, especially after kidney transplantation, untreatable pruritus, pathologic fractures, bone pain refractory to medical treatment, and metastatic calcifications. Unfortunately, this latter complication does not respond to parathyroidectomy, and blood vessels calcifications are associated with increased mortality. Severe osteitis fibrosa and bone deformities also never disappear. Thus, new criteria for early parathyroidectomy are needed. Serum intact PTH higher than 10 times the upper limit of normality despite adequate calcium and calcitriol supplements, calcium-phosphorus product higher than 70(mg/dL) 2 , "brown tumor" whenever a rapid regression is needed, incapacitating arthritis and/or periarthritis, and rupture of tendons are among other indications that should be considered. Care must be taken to exclude concomitant diseases such as amiloidosis and aluminum intoxication. This review intends to advise endocrinologists about the indications and timing of surgery in hyperparathyroidism due to chronic renal failure.

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“…The mortality rates of patients with calciphylaxis are high, and the main reason for death is sepsis. It is not clear how long this interval is leading death after the development of calciphylaxis (4,11). Likewise, the present patient died secondary to sepsis after one month of hospitalization.…”

Section: Discussionmentioning

confidence: 62%

“…Although it has been seen almost exclusively in patients with end stage renal diseases and hyperparathyroidism, some patients without renal and parathyroid dysfunction develop calciphylaxis (3). It is characterized by skin lesions, subcutaneous nodules, skin necrosis, ulceration, and escar formation (4). Its histology reveals medial calcification and intimal hyperplasia of dermal and subcutaneous small arteries often accompanied by microthrombosis (5).…”

Section: Introductionmentioning

confidence: 99%

Development of Calciphylaxis after Long-term Steroid and Methotroxate Use in a Patient with Rheumatoid Arthritis

et al. 2005

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Risk factors and mortality associated with calciphylaxis in end-stage renal disease

Abstract: Female gender, hyperphosphatemia, high alkaline phosphatase, and low serum albumin are risk factors for calciphylaxis. Calciphylaxis is associated with a very high mortality.

Cited by 292 publications

References 19 publications

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Sodium Thiosulfate Therapy for Calcific Uremic Arteriolopathy

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

Development of Calciphylaxis after Long-term Steroid and Methotroxate Use in a Patient with Rheumatoid Arthritis

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