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Transcutaneous oxygen tension in patients with calciphylaxis
W A Wilmer1, O Voroshilova, I Singh
1Department of Internal Medicine, Division of Nephrology, Ohio State University, Columbus, OH, USA. wilmer.1@osu.edu
Summary
Calciphylaxis patients exhibit significantly reduced skin oxygenation (TCPO2) compared to controls, indicating widespread ischemia even in unaffected areas. This suggests a fixed insufficiency of skin vessels, detectable via noninvasive measurements.
Area of Science:
- Nephrology
- Dermatology
- Vascular Medicine
Background:
- Calciphylaxis is a severe complication of chronic renal failure, primarily affecting dialysis patients.
- Histological findings include small-vessel calcifications leading to tissue ischemia and necrosis.
- Noninvasive assessment of skin oxygenation is crucial for understanding disease extent.
Purpose of the Study:
- To investigate the extent of skin ischemia in calciphylaxis using transcutaneous oxygen tension (TCPO2) measurements.
- To compare TCPO2 levels in calciphylaxis patients versus controls.
- To explore correlations between TCPO2 and clinical factors.
Main Methods:
- TCPO2 measurements were performed on 21 calciphylaxis patients and 21 controls.
- Measurements were taken at the chest, abdomen, and thigh under room air and 100% oxygen.
- Data were analyzed for correlations with weight, hemodialysis, PTH, calcium, and phosphorus.
Main Results:
- Calciphylaxis patients had significantly lower TCPO2 levels across all measured body regions compared to controls.
- Low TCPO2 levels were observed in both lesional and non-lesional skin areas in calciphylaxis patients.
- TCPO2 levels showed limited improvement with 100% oxygen in calciphylaxis patients, suggesting vascular insufficiency.
Conclusions:
- Patients with calciphylaxis experience severe and diffuse skin ischemia, detectable noninvasively.
- TCPO2 measurements can identify skin ischemia even before visible lesions develop.
- The findings suggest a fixed insufficiency of skin vessels in calciphylaxis, potentially aiding early diagnosis and management.