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

Abstract

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.

Quantifying a Rare Disease in Administrative Data: The Example of Calciphylaxis

“…[27][28][29] Accurate identification of calciphylaxis cases in a large administrative database such as the USRDS also offers the opportunity to study whether certain commonly used therapies in dialysis patients, such as cinacalcet, sevelamer, or statins, offer any protection against calciphylaxis. 25,30,31 Our study also provides fundamental epidemiological data, as future studies related to biomarkers, therapeutic target discovery, and clinical trials are planned for calciphylaxis.…”

Vitamin K Antagonists Predispose to Calciphylaxis in Patients with End-Stage Renal Disease

“…In addition to many anecdotal reports [13,14,15,18], Nigwekar et al reported a strong association with warfarin use (OR = 4.3) in a case-control study including 62 cases of calciphylaxis [15]. In contrast, Weenig et al reported high usage of warfarin, but no association with calciphylaxis in 64 cases and 98 matched controls [4].…”

“…Since MGP gamma-carboxylation status is impaired in haemodialysis patients [9,10], and VKA treatment reduces MGP gamma-carboxylation and promotes medial arterial calcification [11,12], VKA use may also predispose to the development of calciphylaxis. However, data from existing studies are conflicting [4,13,14,15,16]. …”

Long-term Outcomes of Parathyroidectomy in Kidney Transplant Recipients with Persistent Hyperparathyroidism

“…There are evidences showing that secondary HPT is associated with increased cardiovascular mortality [6]. Indications for parathyroidectomy (PTX) in kidney transplant recipients include persistent post-transplant HPT combined with severe hypercalcemia, unexplained renal function deterioration, and progressive bone mineral density loss [7][8][9].…”