Calciphylaxis in a Patient on Home Hemodialysis

Abstract

Calciphylaxis is a rare and severe complication characterized by calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue that leads to ischemia, necrosis, and painful skin lesions in patients with end-stage renal disease (ESRD). It is also known as calcific uremic arteriolopathy. Calciphylaxis occurs most commonly with the ESRD with skin ulceration as a predominant presenting feature. Calcium-phosphorus dysregulation in dialysis patients are traditionally considered as a risk factor for the development of calciphylaxis. The involvement of an integrated interdisciplinary and multifaceted approach is key to the success of the calciphylaxis treatment. We present a case of a 51-year-old female with ESRD on home hemodialysis who developed calciphylaxis, which was successfully managed with increasing dialysis prescription, diligent wound care, and sodium thiosulfate infusion. Management of calciphylaxis in a patient receiving home hemodialysis has never been reported as per the review of the literature. Calciphylaxis is a sporadic disease, frequently encountered in the patients undergoing hemodialysis and carries a very grave prognosis. Current treatment is rarely effective, so preventive strategies play an important role by modifying the risk factors that promote the development of calciphylaxis.

Calciphylaxis and Kidney Disease: A Review

“…For this reason, a multi-pronged treatment regimen has been advocated including increased dialysis dose as reported in a home hemodialysis patient who achieved complete healing of a large ulcer with 6 times-a-week dialysis. 77,78 Furthermore, kidney transplantation, the ideal kidney replacement therapy, resulted in full resolution of these calcific skin lesions in case series and in isolated case reports. [79][80][81] As with others, these proposed therapies remain unproven with no controlled studies to support this approach.…”

Scrotal calciphylaxis in a fifty-one-year-old man with end-stage renal disease and prior bacteremia

“…Kidney transplantation and increased dialysis dosing regimens have also been proposed as treatment options to increase renal calcium clearance. 9 , 10 However, both treatments lack data supporting their effectiveness. Similarly, intravenous or intralesional sodium thiosulfate (STS) is commonly used as a treatment for calciphylaxis because thiosulfate has a vasodilatory effect and creates soluble calcium thiosulfate complexes, which decreases calcium-phosphate precipitation in vascular tissue.…”

Successful Treatment of Calciphylaxis in a Young Female With End-Stage Renal Disease on Peritoneal Dialysis With Parathyroidectomy, Intensification of Dialysis, and Sodium Thiosulphate—A Case Report and Literature Review

“… 6 - 8 Obesity is a unique risk factor contributing to the lesions developing in areas like breasts, trunks, and thighs. 14 , 15 …”