Calciphylaxis in End-Stage Renal Disease: A Rare Condition With High Mortality

Abstract

Calciphylaxis is a rare but life-threatening condition, seen in patients with end-stage renal disease (ESRD) on renal replacement therapy. Its pathogenesis is not completely known, but microvascular calcification and thrombosis are considered the likely processes. It is characterized by significant morbidity due to severe pain and nonhealing wounds with frequent hospitalizations. Sepsis is the most common cause of mortality with more than 50% of patients dying within the first year after diagnosis. Optimal management requires a multidisciplinary approach. We describe a case of a 66-year-old female with ESRD on hemodialysis (HD) who presented with severe progressive calciphylaxis wounds on both lower extremities and died within two months after diagnosis. She had multiple admissions in the past for cellulitis when she presented with swelling in the legs and chronic wounds. Our goal is to increase awareness among physicians to include calciphylaxis in their differential diagnosis when treating ESRD patients with significant risk factors to detect it early and prevent morbidity and mortality.

Calciphylaxis: A Rare Clinical Presentation in a Patient with End-Stage Renal Disease (ESRD)

“…Typical findings on skin biopsy usually include a small mural artery, vein calcification, fat necrosis (panniculitis), thrombus formation, and occlusion without obvious inflammation. X-ray of the bone, bone scintigraphy, and anti-nuclear antibody may also be done in some patients [5,13,21]. The patient in this review fits the description and presentation of calciphylaxis.…”

The application of MDT model for calciphylaxis management in patients with end‐stage renal disease

“…4,5 Once the diagnosis of calciphylaxis is confirmed, the prognosis of the patient is extremely poor, with 1-year survival rate less than 50%. 6,7 At present, the aetiology of calciphylaxis is obscure in clinical practice and there is a lack of knowledge of its pathogenic mechanisms, which limits the development of effective therapeutic approaches. 8 In addition, there is no consensus of guidelines for the clinical management of patients diagnosed with calciphylaxis, which is the major challenge in its clinical management.…”

“…Calciphylaxis seriously undermines the life quality of patients, and the incidence rate of the disease in ESKD patients is as high as 4.1% 4,5 . Once the diagnosis of calciphylaxis is confirmed, the prognosis of the patient is extremely poor, with 1‐year survival rate less than 50% 6,7 …”