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Calciphylaxis: the beginning of the end?
1Section of Nephrology, University of Manitoba, Winnipeg, Manitoba, Canada. dr_adrian_fine@yahoo.ca
Summary
Calciphylaxis incidence decreased significantly, possibly due to reduced calcium salt use and switching to hemodialysis (HD). Monitoring ionized calcium levels may have contributed to the high incidence in peritoneal dialysis (PD) patients.
Area of Science:
- Nephrology
- Vascular Medicine
- Dermatology
Background:
- Previous reports indicated a high calciphylaxis incidence, particularly in peritoneal dialysis (PD) patients.
- Identified risk factors included PD, but the specific reasons for a uniquely high incidence and effective treatment remained unclear.
Purpose of the Study:
- To evaluate changes in calciphylaxis frequency and treatment response.
- To investigate potential factors contributing to the center's unusually high incidence of calciphylaxis.
Main Methods:
- Prospective data collection on all calciphylaxis cases (PD and hemodialysis [HD] patients) from 1998 to 2006.
- Analysis of patient demographics, dialysis modality, calcium salt usage, and serum calcium monitoring methods.
Main Results:
- A significant decrease in calciphylaxis incidence was observed, from 4.5/100 patient-years (1998-2003) to 1.3/100 patient-years (2004-2006) in PD patients.
- Reduced calcium salt use correlated with decreased incidence; conversion to HD showed marked improvement.
- Discrepancies between ionized and corrected serum calcium levels were noted, potentially masking hypercalcemia.
Conclusions:
- Calciphylaxis incidence has dramatically decreased, potentially linked to reduced calcium salt usage.
- Switching to hemodialysis (HD) offers significant benefits for calciphylaxis patients.
- The high historical incidence may be associated with the center's practice of monitoring ionized calcium levels.
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