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Clinical characteristics and risk factors associated with mortality in calcific uremic arteriolopathy
Peter W Santos1, Jianghua He2, Ahmad Tuffaha3
1Arizona Kidney Disease and Hypertension Center, 18699 N. 69th Avenue, Suite 280, Glendale, Phoenix, AZ, 85308, USA. psantos@akdhc.com.
Insights
Calcific uremic arteriolopathy (CUA) is a deadly condition in dialysis patients. Cardiovascular disease and warfarin use are linked to increased mortality in CUA patients.
Area of Science:
- Nephrology
- Vascular Biology
- Dermatology
Background:
- Calcific uremic arteriolopathy (CUA) is a severe, often fatal vascular complication in patients undergoing dialysis.
- Existing literature on CUA is primarily based on isolated case reports, limiting comprehensive understanding.
Purpose of the Study:
- To comprehensively characterize the diagnosis, treatment patterns, and outcomes of patients with calcific uremic arteriolopathy.
- To identify clinical factors associated with mortality in CUA patients.
Main Methods:
- An internet-based registry was utilized to gather data on CUA patients.
- Univariate analysis with Cox proportional hazards models was employed to assess mortality risk factors.
Main Results:
- 117 CUA patients were analyzed; 56.7% were clinically diagnosed, and 32.5% underwent biopsy.
- Intravenous sodium thiosulfate (STS) was administered to 54.7% of patients.
- Mortality was 21.6%, with higher risks associated with cardiovascular disease (CVD) and warfarin use.
Conclusions:
- Significant variability exists in CUA diagnosis and treatment in clinical practice.
- Bone and mineral metabolism parameters are often only modestly altered at diagnosis.
- CVD and warfarin use are potential predictors of poorer outcomes in CUA.
Background:
Calcific uremic arteriolopathy (CUA) is an often-fatal condition in dialysis patients. The clinical descriptions and treatments of CUA patients have been confined mostly to case reports. We report a comprehensive characterization of CUA and its associated diagnosis, treatment patterns, and outcome.
Methods:
An internet-based registry collected information about CUA in dialysis patients. Univariate analysis using Cox proportional hazards models estimated hazard ratios of the association between clinical characteristics, laboratory values, and treatments with all-cause mortality.
Results:
A total of 117 CUA patients had adequate information for analysis. The majority of patients (56.7%) were diagnosed clinically, with only 32.5% biopsied. Debridement was undertaken in 42.6% of cases. Intravenous sodium thiosulfate (STS) was initiated in 54.7% of patients; most received ≥ 12.5 g of STS (98.3%) for < 3 months (79.7%). Mean parathyroid hormone (PTH) and phosphorus (P) were 459 ± 492 pg/mL and 6.3 ± 2.1 mg/dL, respectively. A total of 24 patients (21.6%, of 111 with information) died, with a median survival time of 2.9 months. In univariate analysis, higher mortality was observed in patients with cardiovascular disease (CVD; HR = 10.47; 95% CI 1.40-78.38), those taking warfarin at time of diagnosis (HR = 2.74; 95% CI 1.16-6.51), and those who had both diabetes (DM) and CVD and who were taking warfarin (HR = 13.41; 95% CI 1.66-109.29).
Conclusions:
In real-world clinical practice, there is substantial variability in the diagnosis and treatment of CUA. There is usually only modest derangement of bone and mineral parameters at the time of diagnosis. Death is common. The presence of CVD and use of warfarin may influence clinical outcome after diagnosis of CUA.
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