International Journal of Nephrology and Renovascular Disease (Apr 2020)
Calciphylaxis: An Analysis of Concomitant Factors, Treatment Effectiveness and Prognosis in 30 Patients
Abstract
Sarju Panchal,1 Kirstie Holtermann,2 Namrita Trivedi,1 Hariharan Regunath,3 Preethi Yerram4 1Department of Internal Medicine, Hospital of University of Pennsylvania, Philadelphia, PA 19146, USA; 2Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA; 3Department of Medicine – Divisions of Pulmonary, Critical Care and Infectious Diseases, University of Missouri School of Medicine, Columbia, MO 65212, USA; 4Department of Medicine – Division of Nephrology, University of Missouri School of Medicine, Columbia, MO 65212, USACorrespondence: Preethi YerramDepartment of Medicine - Division of Nephrology, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USATel +1 573 882 7992Email [email protected]: Calciphylaxis is a rare but severe complication mostly affecting patients with end-stage renal disease (ESRD) and is associated with high morbidity and mortality. The natural history, concomitant factors, pathogenesis, and treatment for calciphylaxis remain equivocal.Methods: We conducted a retrospective study on patients diagnosed with calciphylaxis in a tertiary care center between January 1, 2012, and December 31, 2017. We describe demographics, co-morbidities, laboratory parameters, effectiveness of sodium thiosulfate treatment and outcomes.Results: Of the 30 patients (age 65.6 ± 12.79 years, male:female = 8:22), 23 (76.67%) had ESRD and were either on hemodialysis (15 [65.22%], median duration 22.5 months [range 0.2– 96 months]) or peritoneal dialysis (8 [34.78%], duration 29± 10 months). Predisposing home medications: 8 (28%) had calcium supplements, 10 (36%) had warfarin, 16 (57%) had vitamin D and 5 (18%) had iron supplements. The median parathyroid hormone (PTH) level was 239.8 pg/mL (range 4.7– 2922). Calciphylaxis was found on extremities in 21 (70%) and on torso in 6 (20%) patients. Sodium thiosulfate (STS) was given for treatment in 20 (67%) patients and 3 were cured in < 2.25 months. One-year survival for all patients with calciphylaxis was 26% (29% for STS group and 20% for those that did not receive STS) and following any surgical treatment regardless of STS use was 14%.Limitations: Retrospective design, absence of a control group and low power.Conclusion: Calciphylaxis was more common among females with a predilection for extremities over the torso. Elevations in PTH and inflammatory markers were common. Treatment with STS did not show a statistically significant improvement in survival. Those who were cured, were treated with STS up to three months.Keywords: calciphylaxis, sodium thiosulfate, calcific uremic arteriolopathy, calcification, non-uremic calciphylaxis
