Hyperbaric oxygen therapy for calcific uremic arteriolopathy: a case series

Area of Science:

• Nephrology
• Dermatology
• Vascular Medicine

Background:

• Calcific uremic arteriolopathy (CUA), or calciphylaxis, is a severe condition causing painful skin lesions and gangrene, primarily in end-stage renal disease patients.
• CUA has high morbidity and mortality with no established standard treatment, though parathyroidectomy has shown mixed results.
• Hyperbaric oxygen therapy (HOT) involves breathing 100% oxygen under pressure to improve tissue oxygenation, aiding wound healing.

Purpose of the Study:

• To evaluate the effectiveness of hyperbaric oxygen therapy (HOT) in treating calcific uremic arteriolopathy (CUA).
• To present the largest retrospective case series of CUA patients treated with HOT.

Main Methods:

• Retrospective analysis of 11 chronic uremic patients undergoing dialysis (hemodialysis or peritoneal dialysis) treated with HOT.
• Patients received varying numbers of HOT sessions, ranging from 20 to 108.
• Data collected included patient demographics, cause of uremia, comorbidities, and treatment outcomes.

Main Results:

• Eight of nine evaluable patients experienced excellent healing of CUA skin ulcers with HOT.
• One patient's condition worsened, necessitating a foot amputation.
• Two patients could not be evaluated due to early interruption or death from unrelated causes.

Conclusions:

• Calcific uremic arteriolopathy (CUA) likely results from multiple factors within the uremic environment.
• Hyperbaric oxygen therapy (HOT) shows promise as a treatment for CUA, particularly in cases without severe secondary hyperparathyroidism.
• Further research is warranted to elucidate the specific triggers of CUA and optimize HOT protocols.