Calcifilaxis: más allá de CKD-MBD

Fernández, M.; Morales, Enrique; Gutiérrez, Eduardo; Polanco, Natalia; Hernández, Eduardo; Mérida, Eva; Praga, Manuel

doi:10.1016/j.nefro.2017.02.006

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…Typical descriptions of calciphylaxis come from patients who undergo dialysis and patients with end-stage renal disease, though there are recorded instances in patients after a kidney transplant [4]. Calcium and phosphate metabolism disorders and hyperparathyroidism (including primary) which accompany renal diseases and long-term dialysis treatment are considered the most important pathogenic factors of the disease [7].…”

Section: Clinical Picturementioning

confidence: 99%

“…Excessive administration of phosphate-binding calcium preparations and inadequately chosen composition of dialysis fluids may contribute to development of calciphylaxis in predisposed patients. It is therefore not surprising that typical descriptions of calciphylaxis concern patients with end-stage renal disease and patients who undergo dialysis [4,13]. On the basis of analysis of calcium and phosphate concentrations it was estimated that the risk of disease is particularly high when the calcium X phosphate product exceeds 60 mg 2 /dL 2 .…”

Section: Risk Factorsmentioning

confidence: 99%

“…End-stage renal disease and related metabolic disorders play the biggest role in commencing vascular destruction. However, such understanding of the disease is a gross oversimplification [4]. Damaging processes begin at the media level Figure 1.…”

Section: Pathogenesismentioning

confidence: 99%

“…Clinical picture is reminiscent of severe necrotizing vasculitis with deep destruction of subcutaneous tissue and formation of non-healing ulcers. However, literature does contain descriptions of cases which are unrelated to kidney failure, with emphasis placed on such factors as pro-inflammatory mechanisms, endothelial damage or loss of balance between activators and inhibitors of extraskeletal calcification [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Calciphylaxis — pathogenesis and clinical picture

Dubiel-Braszczok

Włoch-Targońska

Kotyla

2019

Forum Reumatologiczne

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Calciphylaxis, also known as calcific uremic arteriolopathy (CUA), is a rare vascular disease caused by deposition of calcium salts in vessel walls, accompanied by coagulation disorders, which leads to extensive skin ulceration and soft tissue necrosis. Typical cases of calciphylaxis are usually described in patients with renal failure, though it is currently known that approx. 1/10th of all cases stem from other causes, including systemic inflammation, metabolic disorders and endocrine disorders. This article shows an overview of the most important pathophysiological phenomena which accompany calciphylaxis, characterizes the clinical picture of the disease and presents available approaches to therapeutic management.

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Section: Clinical Picturementioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

Section: Pathogenesismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Calciphylaxis — pathogenesis and clinical picture

Dubiel-Braszczok

Włoch-Targońska

Kotyla

2019

Forum Reumatologiczne

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“…5 A monocentric retrospective study in Spain showed a mortality rate higher in CUA than in non-uremic cases of CP. 6 It has been observed that the risk for death is eightfold higher in patients with CP and associated end-stage renal disease compared to other hemodialysis patients. 7…”

mentioning

confidence: 99%

<p>Management of patients with calciphylaxis: current perspectives</p>

Erfurt‐Berge¹,

Renner²

2019

CWCMR

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Calciphylaxis (CP) is a rare disorder presenting with painful ischemic skin ulcerations. Its association with end-stage renal disease, but also non-uremic cases have been described. Several risk factors, like metabolic syndrome, calcium-phosphate imbalance, anticoagulative medication and female gender have been discussed. Multidisciplinary therapeutic approaches are necessary since evidence-based guidelines are missing due to lack of pathophysiological understanding of the disease and the absence of studies with large patient cohorts. However, strategies for local wound therapy, reduction of risk factors and systemic therapies are being developed. Changes in duration, frequency and method of hemodialysis and specific medication to lower the calcium upload can be effective in uremic CP cases. Systemic treatments with cinacalcet, sodium thiosulfate or bisphosphonates have been applied successfully in CP patients, but large placebo-controlled randomized trials are still needed to gather better insight into this fatal disease.

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Pharmacokinetics, Pharmacodynamics, and Safety of the Novel Calcimimetic Agent Evocalcet in Healthy Japanese Subjects: First-in-Human Phase I Study

et al. 2018

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Background and ObjectivesEvocalcet is a novel calcimimetic agent with potential to improve the treatment of secondary hyperparathyroidism in patients with chronic kidney disease. This study aimed to determine the pharmacokinetics, pharmacodynamics, and safety of evocalcet in healthy Japanese subjects.MethodsThis was a single-blind, placebo-controlled, single-dose study and an 8-day multiple-dose study of evocalcet (MT-4580/KHK7580) in 66 healthy Japanese subjects.ResultsAfter a single dose of evocalcet 1–20 mg, the time to maximum plasma concentration was attained in 1.5–2 h (median), and the elimination half-life was 12.98–19.77 h (mean). Within this dose range, the maximum plasma concentration and area under plasma concentration-time curve increased dose proportionally, confirming linearity. The trough plasma concentrations were relatively unchanged after multiple administration of evocalcet 6 and 12 mg. Evocalcet decreased intact parathyroid hormone and corrected calcium and phosphorus levels in a dose-proportional manner. Regarding its safety, no upper gastrointestinal adverse event occurred after the single and multiple administration of evocalcet at doses up to 12 mg. Tetany was detected in 1 subject (17%) after multiple administration of evocalcet 12 mg. In healthy subjects, the tolerability and safety of evocalcet were observed for a single dose of evocalcet at doses up to 20 mg, and for multiple doses up to 12 mg.ConclusionsThese results suggest that evocalcet may have a comparable efficacy and better safety profile than that of cinacalcet, one of the current treatments for secondary hyperparathyroidism in patients with chronic kidney disease.Electronic supplementary materialThe online version of this article (10.1007/s40261-018-0687-4) contains supplementary material, which is available to authorized users.

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Calcifilaxis: más allá de CKD-MBD

Cited by 11 publications

References 28 publications

Calciphylaxis — pathogenesis and clinical picture

Calciphylaxis — pathogenesis and clinical picture

<p>Management of patients with calciphylaxis: current perspectives</p>

Pharmacokinetics, Pharmacodynamics, and Safety of the Novel Calcimimetic Agent Evocalcet in Healthy Japanese Subjects: First-in-Human Phase I Study

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