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Calciphylaxis epidemiology, risk factors, treatment and survival among French chronic kidney disease patients: a
Raphaël Gaisne1,2, Morgane Péré3, Victorio Menoyo4
1Department of Nephrology and Immunology, Institute of Transplantation Urology and Nephrology, Centre Hospitalier Universitaire de Nantes, Nantes, France. raphael.gaisne@chu-nantes.fr.
Insights
Calcific uremic arteriolopathy (CUA) primarily affects obese patients on Vitamin K antagonists. Malnutrition and inflammation may precede skin lesions, serving as potential warning signs for at-risk dialysis patients.
Area of Science:
- Nephrology
- Dermatology
- Vascular Medicine
Background:
- Calcific Uremic Arteriolopathy (CUA) is a rare, painful condition causing skin ulcers in end-stage renal disease patients.
- Limited recommendations exist for CUA management and treatment, highlighting a gap in clinical practice.
Purpose of the Study:
- To describe the management and outcomes of Calcific Uremic Arteriolopathy (CUA) in a real-world clinical setting.
- To identify risk factors and predictors of survival for CUA patients.
Main Methods:
- Retrospective cohort study of 89 CUA cases identified in western France (2006-2016).
- Cases met Hayashi diagnosis criteria (2013) or had eGFR < 30 mL/min/1.73m².
- Dialyzed CUA patients were compared to matched controls.
Main Results:
- Obesity and Vitamin K antagonist (VKA) use were predominant in CUA patients.
- Malnutrition, inflammation, and bone mineral disease abnormalities preceded CUA onset by 6 months.
- Multimodal treatment included wound care, antibiotics, VKA discontinuation, and intravenous sodium thiosulfate.
- Mortality was high (40.4% within a year), with surgical debridement and non-calcium-based phosphate binders associated with better survival.
- Obesity, VKA, weight loss, low serum albumin, and high serum phosphate were risk factors for CUA in dialysis patients.
Conclusions:
- Calcific Uremic Arteriolopathy predominantly affects obese patients using VKA.
- Malnutrition and inflammation may serve as early warning signs for CUA in at-risk dialysis patients.
Background:
Calcific Uremic Arteriolopathy (CUA) is a rare disease, causing painful skin ulcers in patients with end stage renal disease. Recommendations for CUA management and treatment are lacking.
Methods:
We conducted a retrospective cohort study on CUA cases identified in western France, in order to describe its management and outcome in average clinical practices. Selection was based on the Hayashi diagnosis criteria (2013) extended to patients with eGFR < 30 mL/min/1.73m2. Dialyzed CUA cases were compared with 2 controls, matched for age, gender, region of treatment and time period.
Results:
Eighty-nine CUA cases were identified between 2006 and 2016, including 19 non dialyzed and 70 dialyzed patients. Females with obesity (55.1%) were predominant. Bone mineral disease abnormalities, inflammation and malnutrition (weight loss, serum albumin decrease) preceded CUA onset for 6 months. The multimodal treatment strategy included wound care (98.9%), antibiotherapy (77.5%), discontinuation of Vitamin K antagonists (VKA) (70.8%) and intravenous sodium thiosulfate (65.2%). 40.4% of the patients died within the year after lesion onset, mainly under palliative care. Surgical debridement, distal CUA, localization to the lower limbs and non calcium-based phosphate binders were associated with better survival. Risks factors of developing CUA among dialysis patients were obesity, VKA, weight loss, serum albumin decrease or high serum phosphate in the 6 months before lesion onset.
Conclusion:
CUA involved mainly obese patients under VKA. Malnutrition and inflammation preceded the onset of skin lesions and could be warning signs among dialysis patients at risk.
Trial Registration:
ClinicalTrials.gov identifier NCT02854046, registered August 3, 2016.
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