Calcific uremic arteriolopathy (calciphylaxis) calls into question the validity of guidelines of diagnosis and treatment

Chiriac, Anca; Grosu, Oxana-Mădălina; Terinte, Cristina; Perţea, Mihaela

doi:10.1080/09546634.2019.1618435

Cited by 7 publications

(6 citation statements)

References 18 publications

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“…Favorable dialysis management can reduce the incidence of the disease to a certain extent. Dialysis can be intensified by prolonging dialysis duration, increasing dialysis frequency and using hemofiltration, but intensification beyond the goal of dialysis adequacy is not recommended (5,12). SHPT is a crucial risk factor for calciphylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…The currently accepted diagnostic criteria of calciphylaxis are mainly based on high-risk factors, characteristic skin lesions and histopathological features (23,24), so it's hard to recognize the early stages of the disease (5). Early diagnosis of calciphylaxis patients is a key measure to reduce their high disability rate and high mortality.…”

Section: Discussionmentioning

confidence: 99%

“…Main pathological features are calcification of the subcutaneous adipose tissue and dermal small blood vessel media, along with intimal fibrosis and thrombosis, which lead to tissue ischemic necrosis (1,2). The clinical manifestations of calciphylaxis are persistent painful skin ulcers and erosions in multiple parts of the body, accompanied by black eschar formation (3)(4)(5). And the condition progresses dangerously.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Liu

Yang

et al. 2022

Front. Med.

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BackgroundCalciphylaxis is a grievous life-threatening vascular disease that commonly affects dialysis population. This is the first epidemiological survey of calciphylaxis initiated in China.MethodsIn the cross-sectional survey, a stratified sampling method was used to select 24 dialysis centers in Jiangsu Province. The participants were all adult patients in each center who had been on hemodialysis for more than 6 months. Calciphylaxis patients were uniformly diagnosed based on characteristic skin lesions and histopathological features.ResultsA total of 3,867 hemodialysis patients (average age of 55.33 ± 13.89 years; 61.81% of males) were included. Forty eight cases were diagnosed with calciphylaxis, and prevalence was 1.24%. Among calciphylaxis patients, 33 cases were male, and the average age and median dialysis duration were 53.85 ± 15.17 years and 84.00 (48.00, 138.75) months, respectively. Skin biopsy was performed in 70.83% of calciphylaxis patients, and positive rate was 64.71%. Meanwhile, the positive rate of bone scintigraphy in the diagnosis of calciphylaxis was 62.5%. The prevalence of hyperparathyroidism in case group was as high as 72.92% with longer duration, and 42.86% had undergone parathyroidectomy. Multivariate analysis indicated that increased BMI, prolonged dialysis duration, warfarin therapy, hyperparathyroidism, diabetes, tumors, low serum albumin and high serum alkaline phosphatase levels were high-risk factors for calciphylaxis.ConclusionsThe prevalence of calciphylaxis in Chinese hemodialysis patients was 1.24% according to regional epidemiological survey, but its actual prevalence would be presumably far beyond present data. It's urgent to improve clinical understanding of calciphylaxis, and multifaceted diagnostic methods should be applied for early screening.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Liu

Yang

et al. 2022

Front. Med.

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“…The onset of pain probably precedes the progression of skin lesions, and the degree of pain may be greater than the severity of the lesions [ 20 , 21 ]. Therefore, calciphylaxis should be suspected in high-risk patients who present with extensive, painful ulcer necrosis covered with black eschar after excluding other etiologies [ 22 , 23 ]. However, many patients have atypical skin lesions at an early stage that are likely neglected, such as subcutaneous nodules, papules, purpura, and cellulitis-like erythema [ 11 , 22 ].…”

Section: Skin Lesionsmentioning

confidence: 99%

Early diagnosis strategy of calciphylaxis in dialysis patients

Liu,

Zhang

2023

Renal Failure

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Calciphylaxis, a rapidly progressive and potentially life-threatening vascular calcification syndrome that clinically presents with persistently painful, ulcerative, or necrotizing skin lesions in multiple parts of the body, is predominantly observed in patients treated with dialysis. Early diagnosis of calciphylaxis is a key measure for reducing high disability and mortality. At present, there is no unified diagnostic standard for calciphylaxis, and there is a lack of effective early screening strategies. This paper summarized and discussed the diagnostic accuracy of calciphylaxis based on the latest research worldwide. We propose a modified strategy for the early diagnosis of calciphylaxis, which is suitable for dialysis patients to help clinicians better identify such disease and improve prognosis.

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“… 6 Occasionally, imaging or skin biopsy is performed for confirmation, although clinicians are often fearful that a biopsy will worsen skin lesions. 7 Treatment often involves wound care, measures to optimize nutrition, symptom management, optimizing treatment of mineral and bone abnormalities, and extra dialysis; however, these are often inadequate because many patients eventually succumb to progressive disease.…”

mentioning

confidence: 99%

Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry

Toussaint,

Davies,

Bongetti

et al. 2024

Kidney International Reports

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Calcific uremic arteriolopathy (calciphylaxis) calls into question the validity of guidelines of diagnosis and treatment

Cited by 7 publications

References 18 publications

Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Prevalence and Clinical Characteristics of Calciphylaxis in Chinese Hemodialysis Patients

Early diagnosis strategy of calciphylaxis in dialysis patients

Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry

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