Calciphylaxis: A Rare Complication of Patients Who Required Parathyroidectomy for Advanced Renal Hyperparathyroidism

Abstract

Calciphylaxis is a relatively rare but life-threatening complication in uremic patients. Clinical findings and prognosis were evaluated in six patients who developed calciphylaxis from a group of 1499 patients who underwent parathyroidectomy (PTx) for advanced renal hyperparathyroidism (HPT) in our department from July 1972 to July 2003. The frequency of calciphylaxis was 0.40% (6/1499). Two patients were women and four were men. The mean age was 50.5 years, and the mean duration of hemodialysis (HD) treatment was 14.0 years. In five of six patients, calciphylaxis was classified as distal type; in one case, as proximal type. In three patients, calciphylaxis was diagnosed at the time for PTx. In two patients, calciphylaxis was identified after PTx, although the serum parathyroid hormone (PTH) level was within the appropriate range for dialysis patients. In two patients, calciphylaxis improved after PTx, but two patients required leg and toe amputations after PTx. In one patient with the proximal type of calciphylaxis, the condition occurred when a high PTH level recurred after the initial PTx. The patient died as a result of a serious infection due to uncontrollable skin ulcers. Calciphylaxis is a rare complication in patients who require PTx for renal HPT. Especially the proximal type has a poor prognosis. High levels of the Ca x P product and/or PTH are risk factors. Therefore, this syndrome should be kept in mind and attention should be paid to reduce risk factors. It is important that PTx being performed at the right time in patients with advanced renal HPT refractory to medical treatment.

Long‐Term Outcomes of Total Parathyroidectomy With or Without Autoimplantation for Hyperparathyroidism in Chronic Kidney Disease: A Meta‐Analysis

“…The development of RHPT is almost universal in patients with ESRD. The hallmarks of this disease are abnormalities in serum calcium, phosphate, and PTH levels; high‐turnover bone disease with associated musculoskeletal pain and elevated serum alkaline phosphatase levels; symptomatic pruritus; and vascular and soft‐tissue calcification in the advanced stages of the disease . Despite the initiation of new therapeutic agents and intensified dialysis, there are still patients who develop severe hyperparathyroidism requiring PTX.…”

Clinical Practice Guideline for the Management of Chronic Kidney Disease‐Mineral and Bone Disorder

“…Several studies reported attenuation of progressive vascular calcification (118), regression of tumoral calcinosis (119,120), and amelioration of anemia (121,122), hypertension (121,123) and cardiac function (124)(125)(126) in patients who underwent PTx for severe secondary hyperparathyroidism. Surgical series also reported clinical improvement of calciphylaxis following PTx (127)(128)(129).…”

Surgical Treatment of Secondary Hyperparathyroidism due to Chronic Kidney Disease

“…An additional indication for PTx is the presence of calciphylaxis with an elevated PTH level (>500 pg/mL), as calciphylaxis is a very serious complication in CKD patients (34). In patients who underwent PTx for advanced 2HPT in our department, calciphylaxis was very uncommon (42,43). According to the algorithm published by the Association of European Dialysis Transplantation (EDTA), the size of the parathyroid gland is one of the main factors to consider among the indications for surgery (44).…”