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Risk factors and mortality associated with calciphylaxis in end-stage renal disease
A R Mazhar1, R J Johnson, D Gillen
1University of Washington, Division of Nephrology, Seattle, Washington, USA.
Insights
Calciphylaxis, a severe complication in end-stage renal disease patients, is more common in women and linked to high phosphate and low albumin levels. This condition significantly increases the risk of death.
Area of Science:
- Nephrology
- Dermatology
- Vascular Biology
Background:
- Calciphylaxis is a rare but devastating complication in patients with end-stage renal disease (ESRD).
- Identifying risk factors and understanding mortality associated with calciphylaxis is crucial for patient management.
Purpose of the Study:
- To determine the risk factors associated with the development of calciphylaxis in ESRD patients.
- To assess the impact of calciphylaxis on mortality in this patient population.
Main Methods:
- A case-control study was conducted, identifying 19 cases of calciphylaxis diagnosed between 1989 and 2000.
- Three controls were matched for each case based on hemodialysis initiation date.
- Laboratory data and medication doses were analyzed from the 12 months prior to diagnosis and at the time of diagnosis.
Main Results:
- Female gender was associated with a sixfold increased risk of calciphylaxis (OR = 6.04).
- Lower serum albumin levels and higher serum phosphate levels were significant risk factors.
- Elevated alkaline phosphatase at diagnosis increased calciphylaxis risk by 19% per 10 IU/L increment (OR = 1.19).
- Calciphylaxis independently increased the risk of death eightfold (OR = 8.58).
Conclusions:
- Female sex, hyperphosphatemia, elevated alkaline phosphatase, and low serum albumin are key risk factors for calciphylaxis.
- Calciphylaxis is associated with a significantly high mortality rate in ESRD patients.
Background:
We conducted a case control study to determine risk factors and mortality associated with calciphylaxis in end-stage renal disease.
Methods:
Cases of calciphylaxis diagnosed between December 1989 and January 2000 were identified. Three controls were identified for each hemodialysis patient, with calciphylaxis matched to the date of initiation of hemodialysis. Laboratory data and medication doses were recorded during the 12 months prior to the date of diagnosis and at the time of diagnosis of calciphylaxis. Conditional logistic regression was used to identify risk factors for calciphylaxis. Cox proportional hazards models were used to estimate the risk of death associated with calciphylaxis.
Results:
Nineteen cases and 54 controls were identified. Eighteen patients were hemodialysis patients, and one had a functioning renal allograft. Diagnosis was confirmed by skin biopsy in 16 cases. Women were at a sixfold higher risk of developing calciphylaxis (OR = 6.04, 95% CI 1.62 to 22.6, P = 0.007). There was a 21% lower risk of calciphylaxis associated with each 0.1 g/dL increase in the mean serum albumin during the year prior to diagnosis and at the time of diagnosis of calciphylaxis (OR = 0.79, 95% CI, 0.64 to 0.99, P = 0.037, and OR = 0.80, 95% CI, 0.67 to 0.96, P = 0.019, respectively). There was a 3.51-fold increase in the risk of calciphylaxis associated with each mg/dL increase in the mean serum phosphate during the year prior to diagnosis (95% CI, 0.99 to 12.5, P = 0.052). At the time of diagnosis of calciphylaxis, for each 10 IU/L increment in alkaline phosphatase, the risk of calciphylaxis increased by 19% (OR = 1.19, 95% CI, 1.00 to 1.40, P = 0.045). Body mass index, diabetes, blood pressure, aluminum, and higher dosage of erythropoietin and iron dextran were not independent predictors of calciphylaxis. Calciphylaxis independently increased the risk of death by eightfold (OR = 8.58, 95% CI, 3.26 to 22.6, P < 0.001).
Conclusions:
Female gender, hyperphosphatemia, high alkaline phosphatase, and low serum albumin are risk factors for calciphylaxis. Calciphylaxis is associated with a very high mortality.
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