Low-Calcium Dialysis in Calciphylaxis

Lipsker, Dan; Chosidow, Olivier; Martinez, F.; Challier, E; Françès, Camille

doi:10.1001/archderm.1997.03890420144029

Cited by 40 publications

(15 citation statements)

References 4 publications

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“…Treatment of hypercalcemia in this patient included parathyroidectomy and low‐calcium dialysis. Previous studies suggested using a low‐calcium dialysate for treating calciphylaxis 12,16,17 . A zero‐calcium dialysate has been used during the course of dialysis in order to create a sharp calcium gradient to mobilize extravascular calcium into the intravascular space, which was subsequently removed through the dialysate 18 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of severe metastatic calcification in hemodialysis patients

Yeh¹,

Hwang²,

Chen³

2009

Hemodialysis International

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Soft tissue and vascular calcifications are commonly present in uremic patients secondary to disturbances in calcium and phosphate balance and secondary to hyperparathyroidism. We report a uremic patient who developed uncontrolled hyperparathyroidism rapidly within 6 months after commencing hemodialysis (HD) therapy, with clinical presentations of tumoral calcinosis, calciphylaxis, and myocardial calcifications. After treatment with a low-calcium dialysate, non-calcium-containing phosphate binders, and parathyroidectomy, a dramatic resolution of soft tissue calcification was achieved. However, there was relatively little change in the vascular and other visceral calcifications over the 3-month observation period. This case highlights an unusual and rapid development of tertiary hyperparathyroidism, the importance of tight calcium/phosphate control in uremic patients, the potential hazards of a high calcium concentration dialysate, and the dangers of the overzealous use of active vitamin D therapy in HD patients with uncontrolled hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Treatment of severe metastatic calcification in hemodialysis patients

Yeh¹,

Hwang²,

Chen³

2009

Hemodialysis International

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“…The initial step in therapy is to normalize the serum calcium and phosphate levels, preferably by calcium‐free phosphate binders and a low‐phosphate diet 12,70 . Some authors have advocated the use of low‐calcium dialyzate solutions for peritoneal dialysis and hemodialysis 71 . It has been suggested that affected patients should be dialyzed against a zero‐calcium dialyzate bath, based on the concept that transient episodes of hypocalcemia may improve serum Ca 2+ × PO 4 70 .…”

Section: Treatmentmentioning

confidence: 99%

Calciphylaxis

Guldbakke

Khachemoune

2007

Int J Dermatology

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“…Recently, with STS treatment Zitt et al found a 50 % survival of 3.3 months [30]. Classical treatment recommendations include: intensification of dialysis (increase of frequency and duration [20]) using a low calcium dialysate [17]; cessation of vitamin D preparations as well as calcium containing phosphate binders, steroids, immunosuppressants, blood products; application of bisphosphonates [18]. Yet all these measures did not substantially improve the grim outcome of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Different approaches have been suggested, including emergency parathyroidectomy [16], extensive dialysis against low calcium levels [17], bisphosphonates [18], cessation of steroids and immunosuppressants [19], optimum phosphate control using calcium and aluminium free phosphate binders [20] as well as use of prostaglandin and hyperbaric oxygenation [21]. …”

Section: Introductionmentioning

confidence: 99%

Multi-Modal Treatment Of Calciphylaxis With Sodium-Thiosulfate, Cinacalcet And Sevelamer Including Long-Term Data

Salmhofer

Franzen

Hitzl

et al. 2013

Kidney Blood Press Res

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Background: Calciphylaxis is a rare, yet life-threatening disease mainly occurring in dialysis patients. Traditional options of treatment remain unsatisfactory. Methods: Here we present a novel, combined approach, treating calciphylaxis with IV sodium thiosulfate, cinacalcet and sevelamer. In a case series five hemodialysis patients, have been successfully treated with this regimen. Treatment and survival data were analyzed using descriptive statistics. Results: In all patients, a rapid decrease in pain, improvement of general condition and wound healing within six months occurred. Side effects were low. Drug dosages: IV sodium thiosulfate initial dose 119.4 +/- 84.9 g/m²/week, maintenance dose 40.6 +/- 9 g/m²/week; cinacalcet: maintenance dose 36 +/- 32.9 mg/d and sevelamer maintenance dose 3320 +/-1671 mg/d. One and two year survivals were 100 % and 80 %, respectively. We also report on long-term application of IV sodium thiosulfate of up to 52 months. Patient survival after diagnosis was 52, 84, 21, 36 and 30 months, respectively. Survival since initiation of hemodialysis was 76, 136, 89, 36 and 35 months, respectively. Conclusion: This novel combined approach, a multi-modal treatment of calciphylaxis with persistent hyperparathyroidism, using IV sodium thiosulfate, cinacalcet and sevelamer seems to improve the outcome of this devastating disease.

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Low-Calcium Dialysis in Calciphylaxis

Cited by 40 publications

References 4 publications

Treatment of severe metastatic calcification in hemodialysis patients

Treatment of severe metastatic calcification in hemodialysis patients

Calciphylaxis

Multi-Modal Treatment Of Calciphylaxis With Sodium-Thiosulfate, Cinacalcet And Sevelamer Including Long-Term Data

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