Calciphylaxis in dialysis patients, a severe disease poorly responding to therapies: report of 4 cases

Area of Science:

• Nephrology
• Dermatology
• Vascular Biology

Background:

• Calciphylaxis, or calcific uremic arteriolopathy (CUA), is a rare syndrome primarily affecting end-stage renal disease patients.
• It involves calcium deposition in dermal and subcutaneous small to medium-sized vessels.

Observation:

• This study reports on 4 dialysis patients diagnosed with calciphylaxis.
• Warfarin use was the most frequent predisposing factor (50%), followed by local trauma and diabetes.
• Lower legs were the most commonly affected site (75%).

Findings:

• Biopsy proved crucial for diagnosis and did not worsen ulcers.
• Multimodal therapy included hyperbaric oxygen, cinacalcet, and sodium thiosulphate.
• Despite recent reports, intravenous sodium thiosulphate (5g thrice weekly) did not alter the poor prognosis in these patients.

Implications:

• Warfarin use should be carefully considered in dialysis patients presenting with calciphylaxis symptoms.
• While multimodal therapy is standard, the efficacy of sodium thiosulphate in severe cases warrants further investigation.
• Accurate diagnosis via biopsy is essential for appropriate management of calciphylaxis.