Low-calcium dialysis in calciphylaxis

Lipsker, D.

doi:10.1001/archderm.133.6.798

Cited by 15 publications

(13 citation statements)

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“…Other treatments for calciphylaxis include reducing phosphate levels with non-calcium containing phosphate binders and hyperbaric oxygen therapy. The use of low (or zero) calcium dialysate for patients on intermittent haemodialysis is intriguing [1,2]; however, the benefit would likely be limited by the anticipated small mass clearance of calcium afforded by short treatments, and the rebounding of plasma calcium levels to predialysis levels shortly after the session.…”

Section: Discussionmentioning

confidence: 99%

“…In cases that would not benefit from early parathyroidectomy, alternative strategies have been proposed to control calcium and phosphate homeostasis. The use of non-calcium based phosphate binders and intermittent haemodialysis with low calcium dialysate [1,2] has been of benefit in some but not all patients. One of the most recently suggested therapies is the use of sodium thiosulfate to increase the solubility of calcium deposits [3].…”

Section: Introductionmentioning

confidence: 99%

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Rapid resolution of calciphylaxis with intravenous sodium thiosulfate and continuous venovenous haemofiltration using low calcium replacement fluid: case report

Guerra

Shah

Ross

2005

Nephrology Dialysis Transplantation

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rapid resolution of calciphylaxis with intravenous sodium thiosulfate and continuous venovenous haemofiltration using low calcium replacement fluid: case report

Guerra

Shah

Ross

2005

Nephrology Dialysis Transplantation

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“…Depending on the serum calcium concentration, hemodialysate calcium concentration can be reduced, with appropriate monitoring of blood chemistries. Dialysate calcium concentrations as low as 0-1.0 mEq/L have been used effectively (34)(35)(36)(37). I generally do not recommend using dialysate concentrations lower than 1.25 mEq/L, however, because of risk of hemodynamic instability or cardiac arrhythmias from transient hypocalcemia.…”

Section: Managementmentioning

confidence: 99%

Painful Skin Ulcers in a Hemodialysis Patient

Sprague

2014

Clinical Journal of the American Society of Nephrology

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SummaryCalciphylaxis, also referred to as calcific uremic arteriolopathy, is a relatively rare but well described syndrome that occurs most commonly in patients with late stage CKD. It is characterized by very painful placques or subcutaneous nodules and violaceous, mottled skin lesions that may progress to nonhealing ulcers, tissue necrosis, and gangrene with a 1-year mortality rate >50%. The pathogenesis of calciphylaxis is poorly understood. Risk factors include female sex, obesity, hyperphosphatemia, hypercalcemia, hyperparathyroidism, longer dialysis vintage, hypercoagulable states, and use of calcium-containing phosphate binders and warfarin. Treatment strategies for calciphylaxis are limited by inadequate understanding of its pathophysiology. Therapy is generally focused on correcting disturbances of calcium, phosphorus, and parathyroid hormone metabolism. Additional therapy focuses on decreasing inflammation and on dissolution of tissue calcium deposits with sodium thiosulfate and/or bisphosphonates. Successful treatment generally results in improvement of pain and healing of the lesions within 2-4 weeks, but the disorder generally takes many months to completely resolve.Clin J Am Soc Nephrol 9: 166-173, 2014. doi: 10.2215/CJN.00320113Case Description Abhijit Naik, MD (Renal Fellow). A 54-year-old white man was referred from an outside dialysis clinic for evaluation of necrotic skin lesions. He had a 10-year history of diabetes and hypertension, with ESRD secondary to diabetes. His history was also significant for coronary artery disease, with two prior myocardial infarctions and atrial fibrillation. He had been undergoing thrice-weekly hemodialysis for 2 years with a Kt/V between 1.3-1.4. Three months before presentation he noticed several small firm and very painful nodules on both anterior thighs. He stated that after several weeks the lesions became much larger, black, and spread to the lateral thighs and buttocks. He was treated with mupirocin ointment and a vascular evaluation revealed normal blood flow in his legs. Aside from these painful lesions, he stated that he generally felt "ok." Dialysis had been proceeding without problems. He denied chest pain, dyspnea, abdominal pain, or any gastrointestinal complaints. Review of systems was otherwise unremarkable. He never smoked and drank alcohol very infrequently. Medications included aspirin, amiodarone, simvastatin, famotidine, glipizide, clopidogrel, sevelamer carbonate, hydrocodone, and gabapentin. He had no known allergies.On examination his vital signs were as follows: temperature, 98.8°F; heart rate, 80 beats per minute; BP, 94/60 mmHg, with no orthostatic changes; and respiratory rate, 20 breaths per minute. His BP was generally low, with systolic BP averaging between 90 and 100 mmHg. He was an ill appearing male in mild distress from extremity pain. His lungs were clear and a cardiovascular examination revealed a regular rate and rhythm with a 2/6 holosystolic murmur. His abdomen had normal bowel sounds and was mildly distended with some asc...

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“…Up to now, there are only limited treatment options such as lowering of the calcium phosphate product, parathyroidectomy, hyperbaric oxygen therapy, intensified dialysis, sufficient pain management and sepsis prevention, to mention the most important known ways of dealing with this threatening disease (table 1) [20,21,22,23,24]. Recently, Cicione et al [25] for the first time administered STS for the treatment of calciphylaxis.…”

Section: Calciphylaxismentioning

confidence: 99%

Sodium Thiosulphate: A New Way of Treatment for Calciphylaxis?

Meißner

Kaufmann

Gille³

2007

Dermatology

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Sodium thiosulphate has been used in medicine for almost 100 years. There are some very important areas of application such as cyanide intoxications or the treatment of cisplatin toxicity. Till this day, this compound is almost unknown to most physicians. This is astonishing, especially because there are some promising reports in the literature describing a possibly wider area of application in different domains of medicine such as urology, nephrology or dermatology. Perhaps one of the most exciting and recent domains of sodium thiosulphate use is the treatment of calciphylaxis, providing new options dealing with this severe and mostly lethal illness. The goal of this article is to review the new application possibility of this compound.

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Low-calcium dialysis in calciphylaxis

Cited by 15 publications

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Rapid resolution of calciphylaxis with intravenous sodium thiosulfate and continuous venovenous haemofiltration using low calcium replacement fluid: case report

Rapid resolution of calciphylaxis with intravenous sodium thiosulfate and continuous venovenous haemofiltration using low calcium replacement fluid: case report

Painful Skin Ulcers in a Hemodialysis Patient

Sodium Thiosulphate: A New Way of Treatment for Calciphylaxis?

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