Calciphylaxis presenting in early chronic kidney disease with mixed hyperparathyroidism

Area of Science:

• Nephrology
• Dermatology
• Endocrinology

Background:

• Calciphylaxis is a rare but severe complication of chronic kidney disease (CKD), characterized by vascular calcification, intimal hypertrophy, and thrombosis, leading to painful, nonhealing skin ulcers.
• While primarily seen in dialysis-dependent patients, calciphylaxis also occurs in advanced CKD, post-transplant, and in individuals with primary hyperparathyroidism.
• Current treatment strategies for calciphylaxis have limited success, highlighting the need for novel therapeutic approaches.

Observation:

• A patient with stage-3 CKD and concurrent primary and secondary hyperparathyroidism developed calciphylaxis.
• Subtotal parathyroidectomy alone did not resolve the patient's calciphylaxis or normalize her hyperparathyroidism markers.
• Medical treatment of secondary hyperparathyroidism with cinacalcet led to complete wound healing and resolution of calciphylaxis.

Findings:

• Cinacalcet, a calcimimetic agent, demonstrated significant efficacy in resolving calciphylaxis in a patient with early-stage CKD and complex hyperparathyroidism.
• The case suggests that addressing both primary and secondary hyperparathyroidism is crucial for successful calciphylaxis management.
• Complete resolution of calciphylaxis was achieved only after the addition of cinacalcet to the treatment regimen.

Implications:

• Cinacalcet may represent a valuable therapeutic option for managing calciphylaxis, particularly in patients with underlying hyperparathyroidism.
• This case underscores the importance of comprehensive management of hyperparathyroidism in patients with CKD presenting with calciphylaxis.
• Further research into the role of cinacalcet and other calcimimetics in calciphylaxis treatment is warranted to improve patient outcomes.