Calciphylaxis: Beyond CKD-MBD

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

doi:10.1016/j.nefroe.2017.09.003

Cited by 8 publications

(6 citation statements)

References 30 publications

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“… 16 It has been increasingly identified in non‐uremic and even normal renal function settings, and we use the concept of NRC to refer to a phenomenon that occurs in people with normal renal function. 17 , 18 Our search of all NRC cases published to date showed an explosion in the amount of literature since the 21st century, suggesting a rising incidence of NRC; alternatively, increased awareness that the condition can occur outside of ESRD and related metabolic disorders may have led to a greater number of cases being diagnosed and ultimately reported in the literature. Calciphylaxis should be considered in evaluating of skin lesions in patients with susceptible diseases, even in the presence of completely normal renal function.…”

Section: Discussionmentioning

confidence: 99%

“…Calciphylaxis, characterised by an insidious asymptomatic medial arteriolar calcification and secondary ischemic skin lesions, is a rare but severe and potentially fatal calcified angiopathy 16 . It has been increasingly identified in non‐uremic and even normal renal function settings, and we use the concept of NRC to refer to a phenomenon that occurs in people with normal renal function 17,18 . Our search of all NRC cases published to date showed an explosion in the amount of literature since the 21st century, suggesting a rising incidence of NRC; alternatively, increased awareness that the condition can occur outside of ESRD and related metabolic disorders may have led to a greater number of cases being diagnosed and ultimately reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Dang

Zha

et al. 2022

International Wound Journal

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Background Normal‐renal calciphylaxis (NRC) is a devastating calcific vasculopathy characterised by refractory wounds. It is more likely to be misdiagnosed because of the absence of renal insufficiency. Failure to effectively control may lead to rapid deterioration and ultimately death. However, current knowledge of it is still inadequate. Objectives To provide a relatively comprehensive review of NRC. Methods Nine electronic medical databases including PubMed, Web of Science, Embase, the Cochrane Library and so on were searched from inception to April 1, 2022. Articles in which calciphylaxis was diagnosed in patients with normal renal function were included. Results Totally 140 articles were retrieved with 187 patients (median age, 62 years [IQR, 49.63 ~ 75.70 years]; 83.42% female; 84.5% Caucasian). Vitamin K antagonism (43.32%) and diabetes (39.57%) accounted for most of the concomitant factors. Cutaneous presentations were the most common. Pathological confirmation was made in 97.86% of patients with an accuracy of 99.45%. Multidisciplinary therapeutic strategies were usually implemented while the final prognosis was not ideal, with a 6‐month mortality rate of 21.10% and a 1‐year mortality rate of 27.52%. Conclusion NRC is an under‐recognised disease caused by a variety of factors; meanwhile, multidisciplinary efforts are required to inform diagnostic and therapeutic decisions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Dang

Zha

et al. 2022

International Wound Journal

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“…The abnormal increase in PTH secretion accelerates bone turnover, causing bone lesions such as osteitis fibrosa and promotes vascular calcification, resulting in cardiovascular disorders [ 5 ]. Thus, SHPT is one of the major factors in the reduced quality of life and increased mortality in patients with end-stage CKD [ 1 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

First-in-Human Phase I Study of the Novel Injectable Calcimimetic Agent Upacicalcet in Healthy Adult Japanese Participants

et al. 2022

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Background and Objective Upacicalcet sodium hydrate is a novel small-molecule calcimimetic and has potential as a therapeutic agent for secondary hyperparathyroidism. We assessed the pharmacokinetics, pharmacodynamics, safety, and tolerability of a single intravenous dose of upacicalcet in Japanese healthy adults. Method This was a single-center, double-blinded, randomized, placebo-controlled, dose-escalation study. For each cohort, eight subjects were randomly assigned at a ratio of 3:1 to receive a single injection of placebo or upacicalcet 0.01, 0.1, 1.0, or 2.5 mg. Result The plasma concentration of upacicalcet increased in a dose-dependent manner. Upacicalcet rapidly disappeared from plasma after administration. The half-life of upacicalcet was approximately 1–2 h. The major excretion route of upacicalcet was via urine. Serum intact parathyroid hormone decreased in accordance with the upacicalcet dose, from the lowest dose of 0.01 mg. Gastrointestinal disorders occurred in one patient in the 1.0 mg group and in five patients in the 2.5 mg group. All adverse events were nonserious, and no symptomatic hypocalcemia occurred. Conclusion This study showed that upacicalcet acted as a calcimimetic and was excreted in the urine unchanged with little metabolism. Moreover, upacicalcet is a small molecule and has a small volume of distribution. In addition, less than 50% of upacicalcet binds to human plasma proteins. These findings suggest that upacicalcet administered to patients undergoing hemodialysis might be expected to have a long excretion period and sustained pharmacological effect.

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“…As a result of protein-energy wasting (PEW) 's effect on nutrients, the in uence of in ammatory factors and the ltering effect of hemodia ltration (HDF) [1][2][3][4] , hypoalbuminemia is commonly observed in MHD patients. A series of studies have shown that serum albumin also serves an important factor for assessing malnutrition and predicting the survival of patients undergoing hemodialysis [5][6][7] . In hemodialysis patients, the risk of death was reported to increase by at least vefold when serum albumin levels dropped to 30 to 35 g/L 8 .…”

Section: Introductionmentioning

confidence: 99%

Association between anorexia and hypoalbuminemia in the patients undergoing maintenance hemodialysis

Yang

Huang

et al. 2022

Preprint

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Introduction: Hypoalbuminemia is commonly observed in maintenance hemodialysis (MHD) patients and can serve as an important predictor of death in MHD patients. Anorexia is one of the important factors leading to hypoalbuminemia in MHD patients, so the purpose of this study was to examine the possible association between hypoalbuminemia and anorexia in MHD patients. Methods: Patients from three blood purification centers in Nanning, Guangxi, China, who met the inclusion criteria were selected. Anorexia was assessed by appetite assessment questionnaire. The presence of hypoalbuminemia was determined based on the level of serum albumin. Thereafter, an association between hypoalbuminemia and anorexia was analyzed using multiple logistics regression. Results: A total of 319 participants, age 54.80±15.41 (62.7% male), were included in the study. In this study,the prevalence of hypoalbuminemia was 22.3% (71) and the prevalence of anorexia was 34.2% (109). According to multiple logistics regression analysis, hypoalbuminemia and anorexia were independently correlated in Crude Model 1(OR:4.235 95%CI: 2.436 to 7.362 P＜0.001) and Adjust Model (OR:3.447 95%CI:1.654 to 7.185 P=0.001). In addition, age and symptom score were established as important risk factors for hypoalbuminemia(P＜0.001); Body Mass Index (BMI), weekly dialysis frequency and serum total calcium (TCa) were identified as protective factors for hypoalbuminemia(P＜0.001). Conclusions: Anorexia is an independent risk factor for the occurrence of hypoalbuminemia. In MHD patients, the incidence of anorexia and hypoalbuminemia can increase significantly with increasing age, and can lead to a significant decline in the quality of life. In the future, further studies are needed to further verify the relevant mechanisms between them, to provide reference for clinical intervention in MHD patients.

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Calciphylaxis: Beyond CKD-MBD

Cited by 8 publications

References 30 publications

Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

Refractory wounds induced by normal‐renal calciphylaxis: An under‐recognised calcific arteriolopathy

First-in-Human Phase I Study of the Novel Injectable Calcimimetic Agent Upacicalcet in Healthy Adult Japanese Participants

Association between anorexia and hypoalbuminemia in the patients undergoing maintenance hemodialysis

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