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Calciphylaxis in Stage 3 Chronic Kidney Disease on Apixaban Successfully Treated With Sodium Thiosulfate: A Case
Faria Ali1, Tarvinder Matharu1, R Venkata Nagesh1
1Henry Ford Health System, Jackson, MI.
Insights
Calciphylaxis, a severe arterial calcification condition, can occur in patients with chronic kidney disease (CKD) even without dialysis or warfarin. Intravenous sodium thiosulfate effectively treated a case in a stage 3 CKD patient, improving prognosis.
Area of Science:
- Nephrology
- Dermatology
- Vascular Medicine
Background:
- Calciphylaxis is a severe condition characterized by arterial calcification, frequently affecting patients with end-stage renal disease on hemodialysis.
- It leads to tissue ischemia, skin ulcers, and has a poor prognosis, with limited established treatment guidelines.
- While warfarin use has been linked to calciphylaxis, its occurrence in non-dialysis CKD patients without warfarin is rarely reported.
Introduction:
Calciphylaxis is a serious condition that often occurs in patients with end-stage renal failure undergoing hemodialysis, with potential comorbidities of hyperparathyroidism and chronic kidney disease (CKD). It is a result of progressive calcification in small- and medium-sized arteries. Causing ischemia in multiple organs and skin ulcers, calciphylaxis has a poor prognosis. No definitive therapeutic or diagnostic guideline exists to prevent the devastating consequences of calciphylaxis. Association of warfarin with calciphylaxis has been reported in the literature, but, to the authors' knowledge, there are no literature reports of patients with CKD who were not on dialysis or warfarin developing calciphylaxis.
Objective:
The authors report an unusual case of calciphylaxis in a patient with stage 3 CKD who was not on dialysis, warfarin, or insulin.
Case Report:
A 72-year-old female with a history of type 2 diabetes mellitus, who was not taking subcutaneous insulin and had stage 3 CKD, was diagnosed with calciphylaxis by skin biopsy. She was treated with intravenous sodium thiosulfate twice weekly for 2 months with complete resolution of skin lesions.
Conclusions:
This case illustrates that early diagnosis, intervention, and a multidisciplinary approach are of utmost importance in the management of calciphylaxis. Sodium thiosulfate, when used in the correct setting, can improve prognosis in patients. Serious consideration should be given to sodium thiosulfate as a practical measure of treatment.
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