Introduction:
Calciphylaxis, or calcific uremic arteriolopathy, is a rare but potentially severe condition primarily seen in patients with end-stage renal disease. It is characterized by cutaneous arteriolar calcification and subsequent tissue ischemia and infarction and causes painful skin lesions.
The incidence of calciphylaxis in dialysis patients ranges from 0.04% to 4%.
The exact cause and mechanism of calciphylaxis is poorly understood. Its development is likely thought to be influenced by a combination of factors that contribute to the calcification of the medial layer of arterioles. This calcification, combined with endothelial injury and the formation of microthrombi, leads to luminal narrowing and occlusion further reducing blood flow. These vascular changes result in tissue ischemia, necrosis, and ulceration.
This study aims to investigate the outcome in patients with end-stage renal failure on haemodialysis, who developed calciphylaxis over 10 year period in 2 satellite haemodialysis units in Northamptonshire, United Kingdom.
Methods:
Retrospective data collection
Patient’s data collected from 2 satellite haemodialysis units
Data collected over a period of 10 years (From August 2014 – August 2024)
Electronic patient’s records were reviewed to verify diagnosis and interventions used.
Results:
Total Number of patients with calciphylaxis from collected data- 14
Male: Female ratio - 4 (28.57%%) : 10 (71.43%)
Mortality rate related to calciphylaxis- 57.14% (8/14): All deaths were in the 1st year of diagnosis.
(4 patients died from unrelated causes, 2 patients are alive)
Main risk factors noted in the study were use of Warfarin, Calcium based phosphate binders, Activated Vitamin D.
Main treatment modalities that improved the outcome were increasing the duration of haemodialysis, sodium thiosulfate, good wound care and minimising risk factors.
Conclusions:
Calciphylaxis has a poor prognosis with 1-year mortality rates between 45% and 80%.
It is associated with substantial morbidity due to severe pain, non-healing wounds, and frequent hospitalizations.
Clinicians should have a high index of suspicion for calciphylaxis in a patient with end-stage renal disease who presents with painful skin lesions.
Treatment of calciphylaxis requires a multidisciplinary approach including input from a nephrologist, dermatologist, dietician, wound care team, pain management specialist and palliative care team.
Further randomised control trials are required to verify the effect of different treatment modalities in improving the outcome of patients with Calciphylaxis.
REFERENCES:
-Westphal SG, Plumb T. Calciphylaxis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519020/
- Nigwekar SU, Kroshinsky D, Nazarian RM, Goverman J, Malhotra R, Jackson VA, Kamdar MM, Steele DJ, Thadhani RI. Calciphylaxis: risk factors, diagnosis, and treatment. Am J Kidney Dis. 2015 Jul;66(1):133-46.
- Nigwekar SU, Zhao S, Wenger J, Hymes JL, Maddux FW, Thadhani RI, Chan KE. A nationally representative study of calcific uremic arteriolopathy risk factors. Journal of the American Society of Nephrology. 2016 Nov 1;27(11):3421-9.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.