Abstract

Case Presentation

Calciphylaxis in Hemodialysis

Luca Sgarabotto*, Paola Baldini Anastasio, Nicola Marchionna and Monica Zanella

Published: 20 July, 2023 | Volume 7 - Issue 2 | Pages: 044-046

Calciphylaxis (CP) or uremic calcific arterial disease (CUA) is a rare, potentially fatal calcific vasculopathy characterized by calcific and thrombotic occlusion of the vessels of the subcutaneous and dermis leading to extremely painful necrotic lesions. It mainly affects patients with end-stage kidney disease (ESKD) and under long time dialysis. The only therapeutic option is represented by intravenous sodium thiosulfate. Currently, clear guidelines are lacking. We have had a good therapeutic response with doses of sodium thiosulfate in association with multidisciplinary management of the patient (vulnologist, dermatologist, nephrologist, dietitian, and cardiologist). There is limited literature on the use of DOAC therapy as a successful alternative to warfarin in patients on dialysis with calciphylaxis. The left atrial appendage closure could represent an important alternative to dicumarolics in patients with atrial fibrillation with calciphylaxis. A new perspective for the treatment of this disease is SNF472 a selective inhibitor of vascular calcification.

Read Full Article HTML DOI: 10.29328/journal.jcn.1001107 Cite this Article Read Full Article PDF

Keywords:

Calciphylaxis; Mineral-bone metabolism; Atrial fibrillation; DOACs; Multidisciplinary management; Secondary hyperparathyroidism

References

  1. Nigwekar SU, Thadhani R, Brandenburg VM. Calciphylaxis. N Engl J Med. 2018 May 3;378(18):1704-1714. doi: 10.1056/NEJMra1505292. PMID: 29719190.
  2. Gallo Marin B, Aghagoli G, Hu SL, Massoud CM, Robinson-Bostom L. Calciphylaxis and Kidney Disease: A Review. Am J Kidney Dis. 2023 Feb;81(2):232-239. doi: 10.1053/j.ajkd.2022.06.011. Epub 2022 Aug 12. PMID: 35970430.
  3. Nigwekar SU, Zhao S, Wenger J, Hymes JL, Maddux FW, Thadhani RI, Chan KE. A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors. J Am Soc Nephrol. 2016 Nov;27(11):3421-3429. doi: 10.1681/ASN.2015091065. Epub 2016 Apr 14. PMID: 27080977; PMCID: PMC5084892.
  4. Wollina U. Update on cutaneous calciphylaxis. Indian J Dermatol. 2013 Mar;58(2):87-92. doi: 10.4103/0019-5154.108026. PMID: 23716795; PMCID: PMC3657275.
  5. Nigwekar SU, Zhao S, Wenger J, Hymes JL, Maddux FW, Thadhani RI, Chan KE. A Nationally Representative Study of Calcific Uremic Arteriolopathy Risk Factors. J Am Soc Nephrol. 2016 Nov;27(11):3421-3429. doi: 10.1681/ASN.2015091065. Epub 2016 Apr 14. PMID: 27080977; PMCID: PMC5084892.
  6. Mawad HW, Sawaya BP, Sarin R, Malluche HH. Calcific uremic arteriolopathy in association with low turnover uremic bone disease. Clin Nephrol. 1999 Sep;52(3):160-6. PMID: 10499311.
  7. Westphal SG, Plumb T. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. 2022 Aug 8.
  8. Baldwin C, Farah M, Leung M, Taylor P, Werb R, Kiaii M, Levin A. Multi-intervention management of calciphylaxis: a report of 7 cases. Am J Kidney Dis. 2011 Dec;58(6):988-91. doi: 10.1053/j.ajkd.2011.06.022. Epub 2011 Aug 26. PMID: 21872378.
  9. Sprague SM. Painful skin ulcers in a hemodialysis patient. Clin J Am Soc Nephrol. 2014 Jan;9(1):166-73. doi: 10.2215/CJN.00320113. Epub 2013 Nov 7. PMID: 24202137; PMCID: PMC3878687.
  10. Zebboudj AF, Imura M, Boström K. Matrix GLA protein, a regulatory protein for bone morphogenetic protein-2. J Biol Chem. 2002 Feb 8;277(6):4388-94. doi: 10.1074/jbc.M109683200. Epub 2001 Dec 6. PMID: 11741887.
  11. Garza-Mayers AC, Shah R, Sykes DB, Nigwekar SU, Kroshinsky D. The Successful Use of Apixaban in Dialysis Patients with Calciphylaxis Who Require Anticoagulation: A Retrospective Analysis. Am J Nephrol. 2018;48(3):168-171. doi: 10.1159/000491881. Epub 2018 Sep 3. PMID: 30176675.
  12. Alasmari MM, Alsheikh MY, Metwali HH. Successful Treatment Using Apixaban in a Patient on Hemodialysis with Uremic Calciphylaxis. Clin Cosmet Investig Dermatol. 2022 Oct 28;15:2329-2333. doi: 10.2147/CCID.S382503. PMID: 36330317; PMCID: PMC9626249.
  13. Genovesi S, Porcu L, Slaviero G, Casu G, Bertoli S, Sagone A, Buskermolen M, Pieruzzi F, Rovaris G, Montoli A, Oreglia J, Piccaluga E, Molon G, Gaggiotti M, Ettori F, Gaspardone A, Palumbo R, Viazzi F, Breschi M, Gallieni M, Contaldo G, D'Angelo G, Merella P, Galli F, Rebora P, Valsecchi M, Mazzone P. Outcomes on safety and efficacy of left atrial appendage occlusion in end stage renal disease patients undergoing dialysis. J Nephrol. 2021 Feb;34(1):63-73. doi: 10.1007/s40620-020-00774-5. Epub 2020 Jul 10. Erratum in: J Nephrol. 2020 Jul 13;: PMID: 32535831; PMCID: PMC7881969.
  14. Sinha S, Gould LJ, Nigwekar SU, Serena TE, Brandenburg V, Moe SM, Aronoff G, Chatoth DK, Hymes JL, Miller S, Padgett C, Carroll KJ, Perelló J, Gold A, Chertow GM. The CALCIPHYX study: a randomized, double-blind, placebo-controlled, Phase 3 clinical trial of SNF472 for the treatment of calciphylaxis. Clin Kidney J. 2021 Jul 6;15(1):136-144. doi: 10.1093/ckj/sfab117. PMID: 35035944; PMCID: PMC8757410.

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