Treatment of severe metastatic calcification in hemodialysis patients

Abstract

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.

Amélioration de la calcinose tumorale de la main droite après para thyroïdectomie chez un hémodialysé chronique

“…Le traitement de la calcinose doit cibler les principaux facteurs précipitants, notamment, l'hyperparathyroïdie secondaire, l'hypocalcémie et l'hyperphosphatémie. Plusieurs rapports de cas ont indiqué que l′hyperparathyroïdie secondaire et la calcinose peuvent être complètement ou remarquablement améliorée après para thyroïdectomie [7, 8], comme le cas de notre patient qui a nettement amélioré sa symptomatologie après para thyroïdectomie. Etant donné que le patient avait également une hyperparathyroïdie, les auteurs ont émis l′hypothèse que les lésions cutanées ont été causées par une sensibilisation à l′hormone parathyroïdienne (PTH).…”

Treatment of a soft tissue calcification in a patient receiving peritoneal dialysis

“…They all focus on aggressive treatment of hyperphosphatemia and avoidance of calcium loading, which appear to be essential to arrest future progress. Thus, medical therapy with discontinuing of calcium‐containing phosphate binders and alfacalcidiol together with a low calcium dialysate is essential in the treatment of soft tissue calcification …”

“…Secondary hyperparathyroidism is often present . Several authors had advocated the use of parathyroidectomy in patients with soft tissue calcifications and severe hyperparathyroidism . In patients receiving hemodialysis complete remission was seen after parathyroidectomy .…”

Tumoral Calcinosis in Nasal Septum in a Patient With Chronic Renal Failure in Dialysis. Presentation of a Case

“…También se mencionan el uso de aluminio con quelantes de fósforo, dieta baja en calcio y fósforo y la hemodiálisis en lugar de la diálisis peritoneal. El Cinacalcet, un agonista de los canales de calcio, se usa en el tratamiento del hiperparatiroidismo secundario y se ha probado en un ensayo clínico como alternativa en la CT (14,24).…”