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Calciphylaxis: An Analysis of Concomitant Factors, Treatment Effectiveness and Prognosis in 30 Patients

Authors Panchal S, Holtermann K, Trivedi N, Regunath H, Yerram P

Received 7 December 2019

Accepted for publication 20 March 2020

Published 5 April 2020 Volume 2020:13 Pages 65—71


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

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, USA

Correspondence: Preethi Yerram
Department of Medicine - Division of Nephrology, University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA
Tel +1 573 882 7992

Background: 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

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