Data Highlight Management, Outcomes of Calciphylaxis in Patients With CKD

Researchers aimed to describe the management and outcomes of calcific uremic arteriolopathy (CUA), or calciphylaxis, in patients with chronic kidney disease (CKD), according to a study published in BMC Nephrology.

CUA is a rare disease that can cause painful skin ulcers in patients who have end-stage renal disease, and there is currently no efficient therapy to treat CUA.

In this retrospective cohort study, researchers analyzed data from 89 cases of CUA identified between 2006 and 2016 in western France. Of the 89 patients, 70 received dialysis and 19 did not. In both dialyzed and nondialyzed patients, the main causes of CKD were diabetes-associated nephropathy (25.7% and 26.3%, respectively), hypertension-associated nephropathy (22.9% and 0%), hypertension- and diabetes-associated nephropathy (15.7% and 21.1%), and glomerular nephropathy (10% and 26.3%).

The majority of cases (55.1%) were identified in obese women, and bone marrow disease abnormalities, inflammation, and malnutrition (including weight loss and serum albumin decrease) preceded the onset of CUA by 6 months. “For the first time, weight loss within the 6 months before CUA onset was identified by our study as a risk factor in dialysis patients,” researchers said.

Obesity was considered as median body mass index of 6.4 lb/ft². In addition, 40.4% of patients passed away within the year after lesions appeared, usually under palliative care.

Researchers found that “surgical debridement, distal CUA, localization to the lower limbs and non-calcium-based phosphate binders were associated with better survival.” The main risk factors associated with developing CUA among dialysis patients were obesity, vitamin K antagonists (VKA), weight loss, serum albumin decrease, or high serum phosphate within the 6 months prior to lesion onset.

Although mainly obese patients receiving VKA contracted CUA, “malnutrition and inflammation preceded the onset of skin lesions and could be warning signs among dialysis patients at risk,” researchers said. Treatment administered to patients included wound care, intravenous sodium thiosulfate (STS), renal replacement therapy modification, and nutritional support therapy.

“Due to its promising treatment properties, STS was frequently administered, but was only associated with a trend toward better prognosis after exclusion of patients treated less than 2 weeks,” researchers said. Trials to better understand the impact of STS on CUA are currently underway.

Reference

Gaisne R, Péré M, Menoyo V, et al. Calciphylaxis epidemiology, risk factors, treatment and survival among French chronic kidney disease patients: a case-control study. BMC Nephrol. 2020;21(63). doi: 10.1186/s12882-020-01722-y.