Management of calcific uremic arteriolopathy (calciphylaxis) with a combination of treatments, including hyperbaric oxygen therapy

Arenas, María Dolores; Gil, María Teresa Nevado; Gutierrez, M. D.; Malek, T; Moledous, A; Salinas, A; Álvarez-Ude, F

doi:10.5414/cnp70261

Cited by 26 publications

(18 citation statements)

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“…Recently, reports have shown high survival rate and complete wound healing with the use of single agent therapy including sodium thiosulphate, hyperbaric oxygen, cinacalcet, and parathyroidectomy [5–9]. Surprisingly, such benefit was not evident in our subjects on multiagent treatment in the form of dual, triple, or quadruple therapies, similar to Kyritsis et al observation [10], but in contrast to better outcome noted by Arenas et al and by Baldwin and colleagues [11, 12]. …”

Section: Discussionsupporting

confidence: 72%

“…Furthermore, favourable outcome was recorded in limited reports on CUA using cinacalcet or parathyroidectomy to achieve targeted normalised calcium, phosphate, and parathyroid hormone levels [8, 9]. Yet usefulness of these agents in the form of combination therapy has not been fully explored [10, 11]. The aim of the study was to review all cases of CUA seen in the last five years and determine its clinical course in the setting of multimodality care.…”

Section: Introductionmentioning

confidence: 99%

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Calcific Uremic Arteriolopathy on Multimodal Combination Therapy: Still Unmet Goal

Malabu

Manickam

Kan

et al. 2012

International Journal of Nephrology

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Background. Calcific uremic arteriolopathy (CUA) or calciphylaxis though generally noted for its high mortality, recent case reports have shown promising results using single agent therapies. However, it is not clear whether combination therapeutic agents will improve course of the disease. Objective. To determine clinical outcome in subjects with CUA on multimodal treatment. Methods. All patients with end-stage renal failure (ESRF) at The Townsville Hospital, Australia, from April 1, 2006, to March 31, 2011, with diagnosis of CUA were retrospectively studied. Results. Six subjects with CUA (4 females and 2 males) were on various combination therapeutic agents comprising sodium thiosulphate, hyperbaric oxygen, prednisolone, cinacalcet, and parathyroidectomy in addition to intensified haemodialysis, specialist local wound care, and antibiotics. The wounds failed to heal in 3 patients while 5 of the 6 subjects died; cause of death being sepsis in 3 and myocardial infarction in 2. Conclusion. Prognosis of CUA remains poor in spite of multimodal combination therapy. Further prospective studies on a larger population are needed to verify our findings.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Calcific Uremic Arteriolopathy on Multimodal Combination Therapy: Still Unmet Goal

Malabu

Manickam

Kan

et al. 2012

International Journal of Nephrology

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“…Successful use of hyperbaric oxygen therapy was described for wound management. 14,15 The reporting of successful and fruitless therapeutic interventions for wound management in NUC is important for compiling the evidence of effective therapeutic strategies.…”

Section: Discussionmentioning

confidence: 99%

Calciphylaxis in Patients With Preserved Kidney Function

Maroz

Mohandes

Field

et al. 2014

Journal of the American College of Clinical Wound Specialists

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Calcific uremic arteriolopathy (CUA), also known as calciphylaxis, is a devastating disease typically seen in patients with end stage renal disease. It manifests as extremely painful symmetrical wounds resistant to surgical and medical interventions. The prevalence of CUA among hemodialysis dependent patients was found to be as high as 4.1%. The management of patients with CUA requires a multidisciplinary approach by the medical team, yet often results in a low rate of successful outcomes. Recently, non-uremic calciphylaxis (NUC) has been described in the absence of kidney disease. Limited knowledge exists on the management of NUC and the outcomes of this condition. Herein we describe three clinical scenarios of patients diagnosed with NUC in the absence of permanent or prolonged acute renal pathology. The reporting of successful and fruitless therapeutic interventions for wound management in NUC is important for compiling the evidence of effective therapeutic strategies.

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“…[60][61][62] It has been reported that empiric hyperbaric oxygen therapy might be useful in some calciphylaxis patients. [63][64][65] Steroid treatment and administration of prostaglandin E1 and vasodilators demonstrated no beneficial effect. 26 Improvement of calciphylaxis after intravenous pamidronate therapy has been recently reported as a new alternative therapy.…”

Section: Discussionmentioning

confidence: 99%

Calciphylaxis: A Report of Six Cases and Review of Literature

et al. 2012

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Calciphylaxis is usually a fatal condition that develops in a few chronic renal failure patients, and it is characterized by calcifications in subcutaneous arteries, infarcts in skin, and the neighboring subcutis. Calciphylaxis, once considered as a rare condition, has been reported to have an annual incidence of 1% and a prevalence of 4% in dialysis patients. We describe our clinical experience in six end-stage renal disease patients on dialysis that presented with calciphylaxis and died due to sepsis, and review the pathogenesis, epidemiology, clinical and histopathologic features, and treatment of calciphylaxis. Physicians should initially consider the possibility of calciphylaxis in case of development of skin lesions in chronic renal failure patients with impaired calcium, phosphorus, and parathyroid hormone levels. The most important cause of mortality in this condition is infection. Therefore, differential diagnosis of these lesions from systemic vasculitis in their early stages and withdrawal of immunosuppressive therapy that increases the tendency to infections are essential.

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Management of calcific uremic arteriolopathy (calciphylaxis) with a combination of treatments, including hyperbaric oxygen therapy

Cited by 26 publications

References 0 publications

Calcific Uremic Arteriolopathy on Multimodal Combination Therapy: Still Unmet Goal

Calcific Uremic Arteriolopathy on Multimodal Combination Therapy: Still Unmet Goal

Calciphylaxis in Patients With Preserved Kidney Function

Calciphylaxis: A Report of Six Cases and Review of Literature

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