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

Abstract

Background/Aims: Calciphylaxis is associated with a poor prognosis in dialysis patients, and its pathogenesis remains incompletely understood. Although the use of vitamin K antagonists (VKA) has been implicated, previous reports are conflicting. We aimed to determine if vitamin K antagonists conferred an increased risk of calciphylaxis in patients on dialysis. Methods: We performed a single-centre, retrospective cohort study of 2,234 patients receiving dialysis, and compared the characteristics of those with and without calciphylaxis. Results: We identified 5 cases of calciphylaxis (all female) between January 2009 and December 2013. Overall, 142 patients (6.4%) were treated with VKA during the study period. Calciphylaxis was more common in the VKA group (4 of 142 patients, OR = 61, 95% CI 6.7-546, p = 0.0001). VKA was withdrawn in all cases and treatment instituted with sodium thiosulphate, cinacalcet and supportive measures. All patients recovered, although there was one sudden cerebrovascular death during follow-up. Conclusion: Treatment with VKA predisposes to the development of calciphylaxis.

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

“…Obesity, systemic corticosteroid as well as vitamin K antagonists use besides severe renal HPT were identified as BCT bilateral cervical thymectomy, RCT randomized controlled trial, RS retrospective study, CRS comparative retrospective study, nd no data predisposing factors in the development of calciphylaxis [66,67]. The treatment encompasses local wound care with judicious local debridement and/or excision when severe soft tissue infection ensues.…”

“…Although there were no therapeutic clinical trials conducted, PTX was contemplated only in patients with PTH levels >20 pmol/l sustaining a calcium-phosphorus product consistently above 70 refractory to medical treatment (EL 2c) [70]. The estimated disease-specific survival rate for calciphylaxis 1 year after the diagnosis is 45.8 %, and patients infrequently survive longer than 2 years [66,67,70].…”

“…Until very recently, the recommended surgical procedure for patients with HPT after renal transplantation was similar to that for patients with renal HPT under dialysis, a form of subtotal resection of all parathyroid tissue (usually subtotal PTX or total PTX+AT), because of the increased risk of recurrence if more parathyroid tissue is left in place [34,116] However, despite recent reports suggesting that hypoparathyroidism, even if definitive, is manageable in patients with a good renal function [66,[137][138][139], it seems that the current trend is to be less aggressive for three main reasons:…”

Calciphylaxis in peritoneal dialysis patients: a single center cohort study

“…20 Furthermore, prevalence of well-described calciphylaxis risk factors such as warfarin therapy and obesity was higher in PD patients who developed calciphylaxis compared to previously published prevalence of these risk factors in HD patients who developed calciphylaxis. 3,[5][6][7]18 Thus, it is possible that it is these risk factors and not dialysis modality that dictates calciphylaxis risk. Previous studies have shown that PD is associated with more abnormalities in phosphorous and albumin than HD, especially once residual renal function has deteriorated.…”

“…3,4 Diabetes mellitus, obesity, abnormalities in mineral bone parameters, and warfarin therapy have been described as calciphylaxis risk factors for HD patients. 3,[5][6][7] Cinacalcet has been reported to reduce the risk…”