Materiały źródłowe

• #1 Calciphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK519020/

  Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare but potentially devastating condition most often observed in patients with end-stage renal disease, although it does occasionally develop in patients without renal failure. It is characterized by cutaneous arteriolar calcification and subsequent tissue ischemia and infarction and causes painful skin lesions. Calciphylaxis is associated with substantial morbidity due to severe pain, non-healing wounds, and frequent hospitalizations. It is a highly fatal condition with 1-year mortality rates greater than 50 percent, most frequently due to sepsis. This activity describes the evaluation and management of calciphylaxis and highlights the role of the interprofessional team in improving care for affected patients. […] Given the possible role of bone-mineral disorders in the pathophysiology of calciphylaxis, careful attention should be paid to avoid hypercalcemia, with phosphorus levels maintained at less than 5.5 mg/dL. At a minimum, dialysis adequacy criteria should be met, and dialysis frequency can be increased if necessary to optimize the clearance of uremic molecules and improve bone-mineral markers. Patients should discontinue the use of calcium supplements, and calcium-based phosphate binders should be converted to non-calcium containing binders. High calcium dialysate baths (greater than 2.5 meq/L) should also be avoided. The parathyroid hormone should be maintained between 150-300 ng/mL. For patients with secondary hyperparathyroidism, cinacalcet, a calcimimetic agent used to lower parathyroid hormone, should be used in place of activated vitamin D to avoid increasing serum calcium and phosphorus levels.

• #1 Calciphylaxis (Calcific uremic arteriolopathy) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/calciphylaxis-calcific-uremic-arteriolopathy/

  The diagnosis of calciphylaxis, also known as calcific uremic arteriolopathy (CUA) in the setting of end-stage renal disease (ESRD), is a rare yet often fatal condition caused by calcification of dermal arterioles. […] Accurate diagnosis and treatment is critical, as prognosis is dismal. […] Clinically the lesions of calciphylaxis are heterogeneous; however patients often first report dysesthesia in a small area of erythema or livedo reticularis prior to the rapid eruption of multiple tender, violaceous nodules or plaques. […] Lesions are usually symmetric, bilateral, and well-demarcated, typically overlying thick adipose tissue (usually as trunk, buttocks, and thighs) or areas of trauma (including heparin or insulin injections). […] Complications include secondary wound infection and gangrene. The leading cause of death is sepsis.

• #1 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Our caring team of Mayo Clinic experts can help you with your calciphylaxis-related health concerns. […] Wound care is a crucial part of calciphylaxis treatment. So it can be very helpful to have a team of wound care specialists. […] For sores to heal, some of the tissue damaged by calciphylaxis may need to be removed with surgery. This is called debridement. […] Antibiotics can help treat and prevent ulcer infections. […] You’ll likely be offered medicines to manage pain due to calciphylaxis or during wound care. A pain medicine specialist may need to be involved if you’re prescribed opioid pain medicines.

• #1 Calciphylaxis: Pictures, Definition, Symptoms, Treatment, and Outlook

  https://www.healthline.com/health/calciphylaxis

  Calciphylaxis is a kidney complication causing calcium buildup inside fat and skin blood vessels. It leads to painful skin lesions and often causes serious infection. Clinical trials are investigating treatments. […] Currently, an effective treatment or cure for calciphylaxis isn’t yet available. Today’s treatments focus on: caring for the skin lesions, preventing infections, correcting blood concentrations of calcium and phosphorous. […] Treating the related wounds and lesions might include: enzymatic debriding agents, hydrocolloid or hydrogel dressings, systemic antibiotics (if infection is a concern), hyperbaric oxygen therapy, surgical debridements (removal of damaged or dead wound tissue). […] Since calciphylaxis is often debilitating, you may need nutritional and psychological support and pain management. […] Successful management of calciphylaxis symptoms is possible, and early diagnosis and treatment can lead to better outcomes even without a cure. The survival rate is expected to improve as more research is performed.

• #1

  https://journals.lww.com/aswcjournal/fulltext/2019/05000/calciphylaxis__diagnosis,_pathogenesis,_and.3.aspx

  Optimization of wound healing entails a three-pronged approach with nutrition support, meticulous wound bed management, and possibly oxygenation augmentation. […] Sodium thiosulfate is now considered by most to be a standard therapy for calciphylaxis. […] Pain management is crucial but is often challenging as pain may not be responsive to even high-dose analgesics.

• #1 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Care should also be taken to prevent any trauma or further skin damage and, therefore, subcutaneous or intramuscular injections should be avoided if possible. Pain management may include the use of narcotics because severe pain is typically present. […] Reduction of risk factors associated with calciphylaxis is another component of care, such as avoidance of warfarin and systemic corticosteroid use. […] Abnormalities in serum calcium and phosphate levels should be corrected with a goal of lowering the plasma calcium-phosphate level to 55 mg2/dL2. […] For patients with chronic kidney disease on hemodialysis, options include increasing the frequency and duration of hemodialysis, using a low calcium dialysate, or temporarily switching to venovenous hemofiltration in patients with rapidly ulcerating calciphylaxis.

• #1 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Calcimimetics (eg, cinacalcet hydrochloride) may be beneficial in cases of hyperparathyroidism. These agents increase the sensitivity of the calcium receptors to available calcium, thereby decreasing parathyroid hormone (PTH) secretion. They have been shown to be effective in lowering PTH, calcium, and phosphate levels. Successful use of these agents as adjunctive therapy for calciphylaxis has been reported. […] Bisphosphonates (eg, pamidronate and etridronate) increase osteoprotegerin production and inhibit arterial calcification. Case reports have suggested that these agents may be helpful in some cases of calciphylaxis, even without changing calcium or phosphate levels. […] Parathyroidectomy should be considered if conservative management fails, but only if hyperparathyroidism is present.

• #1 Calciphylaxis: A Review | JCAD – The Journal of Clinical and Aesthetic Dermatology

  https://jcadonline.com/calciphylaxis-a-review/

  Calciphylaxis is a condition involving vascular calcification and cutaneous necrosis. The mortality rate is high, with more than 50 percent of patients dying within one year of diagnosis. Treatment options include wound care, surgical debridement, sodium thiosulfate, bisphosphonates, and hyperbaric oxygen. Wound care is of utmost importance and should include debridement of necrotic tissue periodically. Systemic antibiotics should be used, if indicated. Opioid pain medications should be used instead of morphine as byproducts of morphine can cause hypotension, thereby, slowing the flow in the pannicular arterioles, and thus increasing the risk of thrombosis. Non-calcium, non-aluminum phosphate binder, such as sevelamer, can be used as an adjunctive therapy. Sodium thiosulfate (STS) has been used for many years for the treatment of cyanide and cisplatin intoxication. Pain relief and reduction in skin lesions after a few weeks of using STS is usually seen. Hyperbaric oxygen therapy (HOT) has been reported to be beneficial in the treatment of cutaneous ulcers in calciphylaxis.

• #1 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Treatment of calciphylaxis requires pain management, wound care, sepsis prevention, and timely referral to specialty care. No evidence-based clinical guidelines on prevention and treatment of the disease are available, and no medications are FDA-approved for calciphylaxis. Medications such as sodium thiosulfate and cinacalcet are used as off-label treatments. The most successful treatment plans are those that include treatment of the underlying issue such as hypercalcemia, hyperparathyroidism, and kidney disease. […] Wound care to decrease sepsis should be taught to patients and caregivers. Home health referral may be needed for adequate wound management in the home environment. If not already involved, a nephrologist referral is needed for patients with nephrogenic-related calciphylaxis. Dermatology referral is essential for assisting in maintaining skin integrity and optimal wound care management.

• #1 Calciphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK519020/

  Wound care and pain management are important. Debridement may be needed to remove devitalized and necrotic tissue, prevent infection, and promote healing. Prophylactic antibiotics are not recommended. However, wounds often become infected, and clinicians should have a low threshold to start antibiotics. Recent reports suggest a possible role of hyperbaric oxygen therapy which has been shown to facilitate wound healing in some patients. […] Treatment of calciphylaxis requires a multidisciplinary approach.

• #1 Calciphylaxis of the penis and distal digits: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-03231-4

  A corollary of the case presented here is the need for more effective management of calciphylaxis, especially for patients in whom uncommon sites, such as the penis, are involved. […] There is currently no consensus on the optimal treatment for calciphylaxis; management is guided by observational studies that advocate for a multimodal approach involving wound care, proper analgesia, infection prevention, and correction of serum calcium and phosphate levels. […] A trial of sodium thiosulfate (STS) is also recommended for all patients with calciphylaxis owing to its reported success in several case series; however, there is a paucity of large-scale clinical trials to support this. […] Even with appropriate management, calciphylaxis is a lethal disease: 6-month mortality rate is estimated to be 50%, with most patients dying from overwhelming infection.

• #1 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. […] However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #2 Calciphylaxis (calcific uremic arteriolopathy) – UpToDate

  https://www.uptodate.com/contents/calciphylaxis-calcific-uremic-arteriolopathy

  Calciphylaxis is a rare and serious disorder that presents with skin ischemia and necrosis and is characterized histologically by calcification of arterioles and capillaries in the dermis and subcutaneous adipose tissue. It is a lethal disease that carries a high morbidity and mortality, with an estimated six-month survival of approximately 50 percent. There is no approved treatment for calciphylaxis. […] Calciphylaxis most commonly occurs in patients who have end-stage kidney disease (ESKD) and are on dialysis but may also occur in kidney transplant recipients and in non-ESKD patients. […] This topic reviews the pathogenesis, diagnosis, and treatment of calciphylaxis in ESKD (calcific uremic arteriolopathy) and non-ESKD patients.

• #2 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Calciphylaxis should be considered in patients presenting with painful nonhealing skin ulcers who have chronic kidney disease, obesity, have been on hemodialysis, and/or are of White race and female sex. Skin changes associated with calciphylaxis have sudden onset and progress rapidly to open ulcerations and then necrosis. A thorough physical examination of the patient, preferably with the torso and lower extremities exposed, can assist the clinician in visualizing the patients lesions and assessing skin integrity. A painful necrotic ulcer covered with black eschar that started as painful ecchymoses is usually the presenting symptom; patients often mistake initial reddening for a bruise and delay seeking medical care. The presence of malodorous, dusky, and/or necrotic lesions should increase suspicion of calciphylaxis. Clinical findings include purple or red net-like areas of ecchymoses that are painful or nonhealing ulcers that are painful. The physical examination may show lesions from shoulder to elbow, elbow to fingertip, and length of the leg from hip to toe.

• #2 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  Routine wound care practices like wound cleansing, debridement, and dressing are vital to the management of patients with ulcerations from calciphylaxis. In some cases, the debridement will be done surgically. […] Nutritionists, and other wound care experts should counsel patients to restructure their diets. Foods with high calcium (milk, yogurt, cheese) and phosphorus (beer, cola, asparagus, nuts, spinach) should be limited and replaced with equally nutritious alternatives where possible. […] Developing calciphylaxis can be a mentally traumatizing experience for patients. Psychological support therapy should be provided to all affected patients to help them cope with the emotional aspects of their condition, as well as help manage treatment expectations. […] With chronic medical conditions such as renal failure, and diabetes mellitus among the key precipitants of the disease, wound care experts must ensure these conditions are adequately controlled using medical or surgical treatments. Well-controlled underlying conditions will improve the prognosis for patients with the condition. […] Patients diagnosed with calciphylaxis may also benefit from newer therapeutic approaches that aim to aid wound healing and reduce blood calcium levels. Examples include: Hyperbaric oxygen therapy, Dialysis support with intravenous sodium thiosulphate, Calcimimetics, Bisphosphonates.

• #2 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Sodium thiosulfate has been administered IV, intralesionally, or topically; intraperitoneal administration is not recommended owing to the risk of chemical peritonitis. It has been used in both adults and children. IV doses have ranged from 5 to 75 g after or during hemodialysis in adults; the most commonly reported dose has been 25 g after each dialysis. Some have used weight-based dosing (especially in children) at 12 g/1.7 m2. Infusion times range from 30 to 60 minutes. […] Although sodium thiosulfate is generally well tolerated, adverse effects have included nausea with emesis and the development of an anion gap metabolic acidosis that can be managed by altering the bicarbonate level of the dialysate. Symptomatic relief and clinical improvement may occur within 2 weeks. […] Oral sodium thiosulfate has also been reported to suppress calciphylaxis, though oral absorption may be poor. A 2 M (molar) solution can be prepared with 74.4 g in 150 mL free water; 2.6 g can be given orally daily or three times a week. Dosing is limited by diarrhea.

• #2 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Care should also be taken to prevent any trauma or further skin damage and, therefore, subcutaneous or intramuscular injections should be avoided if possible. Pain management may include the use of narcotics because severe pain is typically present. […] Reduction of risk factors associated with calciphylaxis is another component of care, such as avoidance of warfarin and systemic corticosteroid use. […] Abnormalities in serum calcium and phosphate levels should be corrected with a goal of lowering the plasma calcium-phosphate level to 55 mg2/dL2. […] For patients with chronic kidney disease on hemodialysis, options include increasing the frequency and duration of hemodialysis, using a low calcium dialysate, or temporarily switching to venovenous hemofiltration in patients with rapidly ulcerating calciphylaxis.

• #2 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Calcimimetics (eg, cinacalcet hydrochloride) may be beneficial in cases of hyperparathyroidism. These agents increase the sensitivity of the calcium receptors to available calcium, thereby decreasing parathyroid hormone (PTH) secretion. They have been shown to be effective in lowering PTH, calcium, and phosphate levels. Successful use of these agents as adjunctive therapy for calciphylaxis has been reported. […] Bisphosphonates (eg, pamidronate and etridronate) increase osteoprotegerin production and inhibit arterial calcification. Case reports have suggested that these agents may be helpful in some cases of calciphylaxis, even without changing calcium or phosphate levels. […] Parathyroidectomy should be considered if conservative management fails, but only if hyperparathyroidism is present.

• #2 Compressing Calciphylaxis – ResusNation

  https://criticalcarenow.com/compressing-calciphylaxis/

  Treatment options include sodium thiosulfate, surgical parathyroidectomy, cinacalcet, bisphosphonates, and HBOT. […] Supporting mechanisms for the rationale for use of HBOT include reversal of local tissue hypoxia acutely, and neovascularization and collagen deposition in the long term. […] Partially attributable to how rare the disease is, data are limited in support of the above-listed treatment options.

• #2 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Treatment of calciphylaxis requires pain management, wound care, sepsis prevention, and timely referral to specialty care. No evidence-based clinical guidelines on prevention and treatment of the disease are available, and no medications are FDA-approved for calciphylaxis. Medications such as sodium thiosulfate and cinacalcet are used as off-label treatments. The most successful treatment plans are those that include treatment of the underlying issue such as hypercalcemia, hyperparathyroidism, and kidney disease. […] Wound care to decrease sepsis should be taught to patients and caregivers. Home health referral may be needed for adequate wound management in the home environment. If not already involved, a nephrologist referral is needed for patients with nephrogenic-related calciphylaxis. Dermatology referral is essential for assisting in maintaining skin integrity and optimal wound care management.

• #2 Calciphylaxis of the penis and distal digits: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-03231-4

  A corollary of the case presented here is the need for more effective management of calciphylaxis, especially for patients in whom uncommon sites, such as the penis, are involved. […] There is currently no consensus on the optimal treatment for calciphylaxis; management is guided by observational studies that advocate for a multimodal approach involving wound care, proper analgesia, infection prevention, and correction of serum calcium and phosphate levels. […] A trial of sodium thiosulfate (STS) is also recommended for all patients with calciphylaxis owing to its reported success in several case series; however, there is a paucity of large-scale clinical trials to support this. […] Even with appropriate management, calciphylaxis is a lethal disease: 6-month mortality rate is estimated to be 50%, with most patients dying from overwhelming infection.

• #2 Calciphylaxis: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/calciphylaxis

  Hyperbaric oxygen therapy may promote wound healing. It involves the wounds receiving exposure to oxygen at a much higher pressure than usual. This helps speed up the healing process. […] The mortality rate for calciphylaxis is around 30% after 6 months and 50% at 12 months. Research suggests that septicemia, or blood poisoning, due to wound infection is the leading cause of death in people with calciphylaxis. […] The earlier a doctor diagnoses a persons symptoms, the sooner they can start treatment to improve outcomes. […] Medical professionals may monitor and attempt to control the mineral and calcium levels in someone with end stage kidney disease to avoid calciphylaxis. […] People should seek prompt medical attention if they think they may have calciphylaxis. This helps rule out other conditions and facilitates early treatment for more positive outcomes.

• #3 Calciphylaxis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK519020/

  Calciphylaxis, also known as calcific uremic arteriolopathy, is a rare but potentially devastating condition most often observed in patients with end-stage renal disease, although it does occasionally develop in patients without renal failure. It is characterized by cutaneous arteriolar calcification and subsequent tissue ischemia and infarction and causes painful skin lesions. Calciphylaxis is associated with substantial morbidity due to severe pain, non-healing wounds, and frequent hospitalizations. It is a highly fatal condition with 1-year mortality rates greater than 50 percent, most frequently due to sepsis. This activity describes the evaluation and management of calciphylaxis and highlights the role of the interprofessional team in improving care for affected patients. […] Given the possible role of bone-mineral disorders in the pathophysiology of calciphylaxis, careful attention should be paid to avoid hypercalcemia, with phosphorus levels maintained at less than 5.5 mg/dL. At a minimum, dialysis adequacy criteria should be met, and dialysis frequency can be increased if necessary to optimize the clearance of uremic molecules and improve bone-mineral markers. Patients should discontinue the use of calcium supplements, and calcium-based phosphate binders should be converted to non-calcium containing binders. High calcium dialysate baths (greater than 2.5 meq/L) should also be avoided. The parathyroid hormone should be maintained between 150-300 ng/mL. For patients with secondary hyperparathyroidism, cinacalcet, a calcimimetic agent used to lower parathyroid hormone, should be used in place of activated vitamin D to avoid increasing serum calcium and phosphorus levels.

• #3

  https://journals.lww.com/aswcjournal/fulltext/2019/05000/calciphylaxis__diagnosis,_pathogenesis,_and.3.aspx

  Calciphylaxis is primarily a disease of renal failure; a majority of patients are nearing or on dialysis. Calciphylaxis that develops in end-stage renal disease (ESRD) patients is classified as uremic calciphylaxis. […] The risk factors for calciphylaxis fall into four major categories. The strongest risk factor is renal failure, with a majority of cases of calciphylaxis developing in dialysis or renal transplant patients. […] Severe pain is a prominent and nearly universal feature of calciphylaxis. Pain, which is believed to be both ischemic and neuropathic in origin, is often out of proportion to the clinically evident skin injuries and can even precede the appearance of skin lesions. […] Treatment of calciphylaxis requires a multidisciplinary approach involving nephrologists, dermatologists, plastic surgeons, dietitians, and wound care specialists.

• #3 Management of patients with calciphylaxis: current perspectives | CWCMR

  https://www.dovepress.com/management-of-patients-with-calciphylaxis-current-perspectives-peer-reviewed-fulltext-article-CWCMR

  The high mortality described for CUA patients is the impetus for an early diagnosis and treatment. […] In a case-control study, a 1-year survival rate of 45% was found for CP patients. […] A monocentric retrospective study in Spain showed a mortality rate higher in CUA than in non-uremic cases of CP. […] It has been observed that the risk for death is eightfold higher in patients with CP and associated end-stage renal disease compared to other hemodialysis patients. […] Concepts of a modern wound management should be followed with special emphasis on debridement and prevention or early treatment of wound infections which are involved in the high mortality of CP patients due to sepsis. […] Non-adhesive modern wound dressings or products with silicone layer can be applied to the wound to enable an atraumatic dressing change and reduce pain.

• #3 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Sodium thiosulfate has been administered IV, intralesionally, or topically; intraperitoneal administration is not recommended owing to the risk of chemical peritonitis. It has been used in both adults and children. IV doses have ranged from 5 to 75 g after or during hemodialysis in adults; the most commonly reported dose has been 25 g after each dialysis. Some have used weight-based dosing (especially in children) at 12 g/1.7 m2. Infusion times range from 30 to 60 minutes. […] Although sodium thiosulfate is generally well tolerated, adverse effects have included nausea with emesis and the development of an anion gap metabolic acidosis that can be managed by altering the bicarbonate level of the dialysate. Symptomatic relief and clinical improvement may occur within 2 weeks. […] Oral sodium thiosulfate has also been reported to suppress calciphylaxis, though oral absorption may be poor. A 2 M (molar) solution can be prepared with 74.4 g in 150 mL free water; 2.6 g can be given orally daily or three times a week. Dosing is limited by diarrhea.

• #3 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Care should also be taken to prevent any trauma or further skin damage and, therefore, subcutaneous or intramuscular injections should be avoided if possible. Pain management may include the use of narcotics because severe pain is typically present. […] Reduction of risk factors associated with calciphylaxis is another component of care, such as avoidance of warfarin and systemic corticosteroid use. […] Abnormalities in serum calcium and phosphate levels should be corrected with a goal of lowering the plasma calcium-phosphate level to 55 mg2/dL2. […] For patients with chronic kidney disease on hemodialysis, options include increasing the frequency and duration of hemodialysis, using a low calcium dialysate, or temporarily switching to venovenous hemofiltration in patients with rapidly ulcerating calciphylaxis.

• #3 Calciphylaxis: A Review | JCAD – The Journal of Clinical and Aesthetic Dermatology

  https://jcadonline.com/calciphylaxis-a-review/

  Calciphylaxis is a condition involving vascular calcification and cutaneous necrosis. The mortality rate is high, with more than 50 percent of patients dying within one year of diagnosis. Treatment options include wound care, surgical debridement, sodium thiosulfate, bisphosphonates, and hyperbaric oxygen. Wound care is of utmost importance and should include debridement of necrotic tissue periodically. Systemic antibiotics should be used, if indicated. Opioid pain medications should be used instead of morphine as byproducts of morphine can cause hypotension, thereby, slowing the flow in the pannicular arterioles, and thus increasing the risk of thrombosis. Non-calcium, non-aluminum phosphate binder, such as sevelamer, can be used as an adjunctive therapy. Sodium thiosulfate (STS) has been used for many years for the treatment of cyanide and cisplatin intoxication. Pain relief and reduction in skin lesions after a few weeks of using STS is usually seen. Hyperbaric oxygen therapy (HOT) has been reported to be beneficial in the treatment of cutaneous ulcers in calciphylaxis.

• #3 Calciphylaxis | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/18769

  Reports have indicated improvement or complete resolution of calciphylaxis lesions following kidney transplantation in patients with end-stage renal disease. […] Primary prevention is of utmost importance in regards to calciphylaxis. Patients should be counseled on compliance with hemodialysis, dietary restrictions, and the use of phosphate binders to prevent the development of this condition. […] Clinicians should have a high index of suspicion for calciphylaxis in a patient with end-stage renal disease who presents with painful skin lesions. […] Treatment of calciphylaxis requires a multidisciplinary approach.

• #3 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Treatment of calciphylaxis requires pain management, wound care, sepsis prevention, and timely referral to specialty care. No evidence-based clinical guidelines on prevention and treatment of the disease are available, and no medications are FDA-approved for calciphylaxis. Medications such as sodium thiosulfate and cinacalcet are used as off-label treatments. The most successful treatment plans are those that include treatment of the underlying issue such as hypercalcemia, hyperparathyroidism, and kidney disease. […] Wound care to decrease sepsis should be taught to patients and caregivers. Home health referral may be needed for adequate wound management in the home environment. If not already involved, a nephrologist referral is needed for patients with nephrogenic-related calciphylaxis. Dermatology referral is essential for assisting in maintaining skin integrity and optimal wound care management.

• #3

  https://link.springer.com/article/10.1007/s12325-020-01504-w

  Local wound treatment regimens should involve removal of wound debris, application of non-adhesive wound dressings, and utilization of antiseptic or antimicrobial agents as needed. […] Wound infection is not uncommon in patients with CP and should be suspected when there is increased drainage, pain, or swelling at the site of the wound. […] While it is important to address any underlying risk factors for calciphylaxis, symptomatic pain management should be sought concurrently with medical management. […] Analgesia is of utmost importance because the pain experienced in CP is frequently disproportionate to the apparent clinical examination and often resistant to opioids. […] Thus, a broad approach to analgesia is required, with should be tailored to individual patient needs. […] Currently, there are multiple clinical trials in progress in order to provide relief to patients with this debilitating disease.

• #4

  https://link.springer.com/article/10.1007/s12325-020-01504-w

  Local wound treatment regimens should involve removal of wound debris, application of non-adhesive wound dressings, and utilization of antiseptic or antimicrobial agents as needed. […] Wound infection is not uncommon in patients with CP and should be suspected when there is increased drainage, pain, or swelling at the site of the wound. […] While it is important to address any underlying risk factors for calciphylaxis, symptomatic pain management should be sought concurrently with medical management. […] Analgesia is of utmost importance because the pain experienced in CP is frequently disproportionate to the apparent clinical examination and often resistant to opioids. […] Thus, a broad approach to analgesia is required, with should be tailored to individual patient needs. […] Currently, there are multiple clinical trials in progress in order to provide relief to patients with this debilitating disease.

• #4 Management of patients with calciphylaxis: current perspectives | CWCMR

  https://www.dovepress.com/management-of-patients-with-calciphylaxis-current-perspectives-peer-reviewed-fulltext-article-CWCMR

  Antiseptics like octenidin, polihexanide or hypochloric acids as well as antimicrobial effective substances are part of the local treatment regimens. […] Removal of necrosis and wound debris is essential but often hard to implement due to pain or the patients multimorbidity. […] While some authors advocate an early, consequent surgical debridement, others prefer less invasive treatment like maggot therapy. […] In summary, local wound therapy in CP patients has to be performed in a professional manner and where available in specialized wound care centers. […] A clear therapeutic recommendation beyond intensive and antimicrobial local wound care cannot be given according to the currently available literature. […] Individual therapeutic decisions have to be made and an evaluation by experienced wound carers has to be ensured.

• #4 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Sodium thiosulfate has been administered IV, intralesionally, or topically; intraperitoneal administration is not recommended owing to the risk of chemical peritonitis. It has been used in both adults and children. IV doses have ranged from 5 to 75 g after or during hemodialysis in adults; the most commonly reported dose has been 25 g after each dialysis. Some have used weight-based dosing (especially in children) at 12 g/1.7 m2. Infusion times range from 30 to 60 minutes. […] Although sodium thiosulfate is generally well tolerated, adverse effects have included nausea with emesis and the development of an anion gap metabolic acidosis that can be managed by altering the bicarbonate level of the dialysate. Symptomatic relief and clinical improvement may occur within 2 weeks. […] Oral sodium thiosulfate has also been reported to suppress calciphylaxis, though oral absorption may be poor. A 2 M (molar) solution can be prepared with 74.4 g in 150 mL free water; 2.6 g can be given orally daily or three times a week. Dosing is limited by diarrhea.

• #4 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Care should also be taken to prevent any trauma or further skin damage and, therefore, subcutaneous or intramuscular injections should be avoided if possible. Pain management may include the use of narcotics because severe pain is typically present. […] Reduction of risk factors associated with calciphylaxis is another component of care, such as avoidance of warfarin and systemic corticosteroid use. […] Abnormalities in serum calcium and phosphate levels should be corrected with a goal of lowering the plasma calcium-phosphate level to 55 mg2/dL2. […] For patients with chronic kidney disease on hemodialysis, options include increasing the frequency and duration of hemodialysis, using a low calcium dialysate, or temporarily switching to venovenous hemofiltration in patients with rapidly ulcerating calciphylaxis.

• #4 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Our caring team of Mayo Clinic experts can help you with your calciphylaxis-related health concerns. […] Wound care is a crucial part of calciphylaxis treatment. So it can be very helpful to have a team of wound care specialists. […] For sores to heal, some of the tissue damaged by calciphylaxis may need to be removed with surgery. This is called debridement. […] Antibiotics can help treat and prevent ulcer infections. […] You’ll likely be offered medicines to manage pain due to calciphylaxis or during wound care. A pain medicine specialist may need to be involved if you’re prescribed opioid pain medicines.

• #4 Calciphylaxis: Symptoms, causes, and treatment

  https://www.medicalnewstoday.com/articles/calciphylaxis

  In addition, the skin lesions may not heal. They may also result in infections, which can occur due to open wounds and usually affect the blood. […] Sepsis is also possible due to calciphylaxis. It occurs when a persons body attacks tissues and organs in response to another infection. Sepsis can be life threatening. […] There are various methods to treat calciphylaxis. Multiple healthcare specialists in nephrology, dermatology, wound care, and pain management will need to coordinate to find the best treatment for an individual. […] The goal of treatment involves: optimizing wound management, stopping the progression of vessel wall calcification, and reversing vessel wall calcification. […] Doctors may use debridement to remove dead tissue from the wounds. This procedure may occasionally involve surgery.

• #5 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Calciphylaxis should be considered in patients presenting with painful nonhealing skin ulcers who have chronic kidney disease, obesity, have been on hemodialysis, and/or are of White race and female sex. Skin changes associated with calciphylaxis have sudden onset and progress rapidly to open ulcerations and then necrosis. A thorough physical examination of the patient, preferably with the torso and lower extremities exposed, can assist the clinician in visualizing the patients lesions and assessing skin integrity. A painful necrotic ulcer covered with black eschar that started as painful ecchymoses is usually the presenting symptom; patients often mistake initial reddening for a bruise and delay seeking medical care. The presence of malodorous, dusky, and/or necrotic lesions should increase suspicion of calciphylaxis. Clinical findings include purple or red net-like areas of ecchymoses that are painful or nonhealing ulcers that are painful. The physical examination may show lesions from shoulder to elbow, elbow to fingertip, and length of the leg from hip to toe.

• #5 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. […] However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #5 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Treatment of calciphylaxis requires pain management, wound care, sepsis prevention, and timely referral to specialty care. No evidence-based clinical guidelines on prevention and treatment of the disease are available, and no medications are FDA-approved for calciphylaxis. Medications such as sodium thiosulfate and cinacalcet are used as off-label treatments. The most successful treatment plans are those that include treatment of the underlying issue such as hypercalcemia, hyperparathyroidism, and kidney disease. […] Wound care to decrease sepsis should be taught to patients and caregivers. Home health referral may be needed for adequate wound management in the home environment. If not already involved, a nephrologist referral is needed for patients with nephrogenic-related calciphylaxis. Dermatology referral is essential for assisting in maintaining skin integrity and optimal wound care management.

• #5 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Patients with abnormalities in calcium and phosphate homeostasis should be referred to a dietitian well versed in the dietary needs and restrictions of patients with end-stage renal disease (ESRD). Special consideration should be given to phosphate restriction. […] The patient’s activity may be greatly hampered by the pain and the ulceration of calciphylaxis lesions. Patients are generally hospitalized in intensive care units (ICUs) during the acute illness. […] Consultation with a surgeon regarding wound debridement and possible parathyroidectomy is appropriate. Consultation with a dietitian regarding dietary alterations is appropriate. Consultation with a pain-management specialist may be warranted.

• #5 Calciphylaxis of the penis and distal digits: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-021-03231-4

  In addition to STS, management of calciphylaxis is multifaceted and involves appropriate analgesia, wound care, infection prevention, and optimization of dialysis. […] Despite theoretical benefits, anticoagulation does not play a major role in management; in fact, warfarin therapy has been established as a risk factor for calciphylaxis, possibly through inhibition of vitamin K-dependent regulatory proteins that prevent vascular calcification. […] Even with prompt initiation of treatment, calciphylaxis portends a dismal prognosis. […] Penile calciphylaxis appears to be especially resistant to accepted treatments and has a 6-month mortality rate of up to 70%. […] This patient’s multisite presentation and failure to improve with standard management indicate that he likely had advanced calciphylaxis. […] Overall, this case highlights the particularly poor prognosis associated with penile calciphylaxis. […] It also underscores the need for more effective management of the disease, especially in patients with multiple comorbidities.

• #6 Calciphylaxis (Calcific uremic arteriolopathy) – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/calciphylaxis-calcific-uremic-arteriolopathy/

  The diagnosis of calciphylaxis, also known as calcific uremic arteriolopathy (CUA) in the setting of end-stage renal disease (ESRD), is a rare yet often fatal condition caused by calcification of dermal arterioles. […] Accurate diagnosis and treatment is critical, as prognosis is dismal. […] Clinically the lesions of calciphylaxis are heterogeneous; however patients often first report dysesthesia in a small area of erythema or livedo reticularis prior to the rapid eruption of multiple tender, violaceous nodules or plaques. […] Lesions are usually symmetric, bilateral, and well-demarcated, typically overlying thick adipose tissue (usually as trunk, buttocks, and thighs) or areas of trauma (including heparin or insulin injections). […] Complications include secondary wound infection and gangrene. The leading cause of death is sepsis.

• #6 Atypical Wounds – Calciphylaxis | AccessMedicine Network

  http://www.accessmedicinenetwork.com/users/253399-rose-hamm/posts/atypical-wounds-calciphylaxis

  Debridement of necrotic tissue and calcified vessels is needed for reversal of the inflammatory response to calciphylaxis; however, this is difficult to perform bedside if the necrosis is extensive because of the intense pain levels associated with the disease. […] In summary, calciphylaxis is a disorder that causes calcification and thrombosis of the cutaneous blood vessels, resulting in painful ischemic skin and subcutaneous wounds that require a multidisciplinary approach for medical and wound management. In addition, rehabilitation services are required to enable the patient to return to the previous level of function, given the involvement of the trunk and lower extremities.

• #6 Advanced-stage calciphylaxis: Think before you punch | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/83/8/562

  A 53-year-old woman presented with extensive, nonulcerated, painful plaques on both calves. […] Treatment was started with cinacalcet, low-calcium dialysis baths, phosphate binders, and sodium thiosulfate. […] Conservative measures are the mainstay of care and include dietary alterations, noncalcium and nonaluminum phosphate binders, and low-calcium bath dialysis. […] Extensive wound debridement should be considered immediately after biopsy or with any signs of ulceration or infectionthis in addition to meticulous wound care, which will promote healing and prevent serious complications secondary to infection. […] A multidisciplinary approach involving surgeons, nephrologists, dermatologists, dermato-pathologists, wound or burn care team, nutrition team, pain management team, and infectious disease team is important to improve outcomes.

• #6

  https://www.kidney.org.uk/calciphylaxis-information

  Speak to your kidney team. Ask them about your blood results and if you need to make any changes. Make sure you let them know how you are feeling and how your symptoms are they can then be guided by you. You will understand your symptoms, and needs, better than anyone and letting people know this will help them to manage your care.

• #7

  https://journals.lww.com/aswcjournal/fulltext/2019/05000/calciphylaxis__diagnosis,_pathogenesis,_and.3.aspx

  Calciphylaxis is primarily a disease of renal failure; a majority of patients are nearing or on dialysis. Calciphylaxis that develops in end-stage renal disease (ESRD) patients is classified as uremic calciphylaxis. […] The risk factors for calciphylaxis fall into four major categories. The strongest risk factor is renal failure, with a majority of cases of calciphylaxis developing in dialysis or renal transplant patients. […] Severe pain is a prominent and nearly universal feature of calciphylaxis. Pain, which is believed to be both ischemic and neuropathic in origin, is often out of proportion to the clinically evident skin injuries and can even precede the appearance of skin lesions. […] Treatment of calciphylaxis requires a multidisciplinary approach involving nephrologists, dermatologists, plastic surgeons, dietitians, and wound care specialists.

• #7 Management of patients with calciphylaxis: current perspectives | CWCMR

  https://www.dovepress.com/management-of-patients-with-calciphylaxis-current-perspectives-peer-reviewed-fulltext-article-CWCMR

  Antiseptics like octenidin, polihexanide or hypochloric acids as well as antimicrobial effective substances are part of the local treatment regimens. […] Removal of necrosis and wound debris is essential but often hard to implement due to pain or the patients multimorbidity. […] While some authors advocate an early, consequent surgical debridement, others prefer less invasive treatment like maggot therapy. […] In summary, local wound therapy in CP patients has to be performed in a professional manner and where available in specialized wound care centers. […] A clear therapeutic recommendation beyond intensive and antimicrobial local wound care cannot be given according to the currently available literature. […] Individual therapeutic decisions have to be made and an evaluation by experienced wound carers has to be ensured.

• #8 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  A significant number of patients who have chronic medical conditions often present with slow-healing wounds as a complication. Among the most serious medical conditions presenting with poorly healing wounds is calciphylaxis. This rare but life-threatening medical condition requires early diagnosis, and proper treatment by wound care professionals to improve patient outcomes. […] Treating patients with calciphylaxis requires a multi-disciplinary approach involving the efforts of an assortment of wound care specialists. General practice doctors, renal specialists, wound care nurses, dieticians, social workers, and physical and occupational therapists are all integral to wound management in calciphylaxis. […] The principles of therapy include: Pain management, Infection control, Local wound care, Nutritional support, Psychological support, Chronic disease management, Other therapeutic options.

• #8

  https://link.springer.com/article/10.1007/s12325-020-01504-w

  Local wound treatment regimens should involve removal of wound debris, application of non-adhesive wound dressings, and utilization of antiseptic or antimicrobial agents as needed. […] Wound infection is not uncommon in patients with CP and should be suspected when there is increased drainage, pain, or swelling at the site of the wound. […] While it is important to address any underlying risk factors for calciphylaxis, symptomatic pain management should be sought concurrently with medical management. […] Analgesia is of utmost importance because the pain experienced in CP is frequently disproportionate to the apparent clinical examination and often resistant to opioids. […] Thus, a broad approach to analgesia is required, with should be tailored to individual patient needs. […] Currently, there are multiple clinical trials in progress in order to provide relief to patients with this debilitating disease.

• #9

  https://link.springer.com/article/10.1007/s12325-020-01504-w

  Local wound treatment regimens should involve removal of wound debris, application of non-adhesive wound dressings, and utilization of antiseptic or antimicrobial agents as needed. […] Wound infection is not uncommon in patients with CP and should be suspected when there is increased drainage, pain, or swelling at the site of the wound. […] While it is important to address any underlying risk factors for calciphylaxis, symptomatic pain management should be sought concurrently with medical management. […] Analgesia is of utmost importance because the pain experienced in CP is frequently disproportionate to the apparent clinical examination and often resistant to opioids. […] Thus, a broad approach to analgesia is required, with should be tailored to individual patient needs. […] Currently, there are multiple clinical trials in progress in order to provide relief to patients with this debilitating disease.

• #10 Perioperative Management of Calciphylaxis: Literature Review and Treatment Recommendations | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/37573-perioperative-management-of-calciphylaxis-literature-review-and-treatment-recommendations

  The resultant clinical effects of calciphylaxis create perioperative treatment challenges. […] Surgical debridement of necrotic ulcers is often necessary to preserve surrounding tissue, and patients may require repeated surgical procedures after diagnosis and near the end of life. […] A thorough history and physical examination should be conducted before surgery with special consideration to baseline pain scores and functional activity because of the debilitating effects of calciphylaxis on patient pain and functional capacity. […] Pain control should be aggressively pursued using a multimodal approach. […] A patient with calciphylaxis and POEMS syndrome who received dexamethasone every 2 weeks had remission of both POEMS syndrome and the calciphylaxis skin lesions. […] For this study, we identified 3 areas of interest that should be considered in postoperative care. […] A multifactorial approach that includes nerve blocks, renal-sparing opioids, benzodiazepines, and/or ketamine is recommended to optimize postoperative pain.

• #11 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Our caring team of Mayo Clinic experts can help you with your calciphylaxis-related health concerns. […] Wound care is a crucial part of calciphylaxis treatment. So it can be very helpful to have a team of wound care specialists. […] For sores to heal, some of the tissue damaged by calciphylaxis may need to be removed with surgery. This is called debridement. […] Antibiotics can help treat and prevent ulcer infections. […] You’ll likely be offered medicines to manage pain due to calciphylaxis or during wound care. A pain medicine specialist may need to be involved if you’re prescribed opioid pain medicines.

• #12 Calciphylaxis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/calciphylaxis/diagnosis-treatment/drc-20370562

  Our caring team of Mayo Clinic experts can help you with your calciphylaxis-related health concerns. […] Wound care is a crucial part of calciphylaxis treatment. So it can be very helpful to have a team of wound care specialists. […] For sores to heal, some of the tissue damaged by calciphylaxis may need to be removed with surgery. This is called debridement. […] Antibiotics can help treat and prevent ulcer infections. […] You’ll likely be offered medicines to manage pain due to calciphylaxis or during wound care. A pain medicine specialist may need to be involved if you’re prescribed opioid pain medicines.

• #13 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. […] However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #14 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. […] However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #15 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Calciphylaxis treatment should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. […] Treatment of calciphylaxis should include a multimodal approach with a focus on supportive care, infection prevention, pain management, and wound healing. The focus should be to normalize calcium, dissolve calcium deposits, and general wound care. […] Wound care consists of wound dressing, debridement, and analgesics. Debridement can be conducted surgically or mechanically with extreme cases potentially requiring amputation. […] However, no standard protocol for debridement exists. Studies have shown that surgical debridement can increase 1-year survival rates from 27.4% without intervention to 61.6%. […] Ulcers are susceptible to infections and antibiotic treatment may be required. Sepsis is a leading cause of mortality in patients; thus, intensive monitoring for signs of (local or systemic) infection is warranted with a low threshold to start systemic antibiotics.

• #16 Calciphylaxis Diagnosis and Management in Primary Care

  https://www.renalandurologynews.com/features/calciphylaxis-diagnosis-treatment-primary-care-2/

  Treatment of calciphylaxis requires pain management, wound care, sepsis prevention, and timely referral to specialty care. No evidence-based clinical guidelines on prevention and treatment of the disease are available, and no medications are FDA-approved for calciphylaxis. Medications such as sodium thiosulfate and cinacalcet are used as off-label treatments. The most successful treatment plans are those that include treatment of the underlying issue such as hypercalcemia, hyperparathyroidism, and kidney disease. […] Wound care to decrease sepsis should be taught to patients and caregivers. Home health referral may be needed for adequate wound management in the home environment. If not already involved, a nephrologist referral is needed for patients with nephrogenic-related calciphylaxis. Dermatology referral is essential for assisting in maintaining skin integrity and optimal wound care management.

• #17 Calciphylaxis Prevention and Treatment Strategies- Clinical Advisor

  https://www.clinicaladvisor.com/features/calciphylaxis-prevention-treatment-strategies/

  Care should also be taken to prevent any trauma or further skin damage and, therefore, subcutaneous or intramuscular injections should be avoided if possible. Pain management may include the use of narcotics because severe pain is typically present. […] Reduction of risk factors associated with calciphylaxis is another component of care, such as avoidance of warfarin and systemic corticosteroid use. […] Abnormalities in serum calcium and phosphate levels should be corrected with a goal of lowering the plasma calcium-phosphate level to 55 mg2/dL2. […] For patients with chronic kidney disease on hemodialysis, options include increasing the frequency and duration of hemodialysis, using a low calcium dialysate, or temporarily switching to venovenous hemofiltration in patients with rapidly ulcerating calciphylaxis.

• #18 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  Routine wound care practices like wound cleansing, debridement, and dressing are vital to the management of patients with ulcerations from calciphylaxis. In some cases, the debridement will be done surgically. […] Nutritionists, and other wound care experts should counsel patients to restructure their diets. Foods with high calcium (milk, yogurt, cheese) and phosphorus (beer, cola, asparagus, nuts, spinach) should be limited and replaced with equally nutritious alternatives where possible. […] Developing calciphylaxis can be a mentally traumatizing experience for patients. Psychological support therapy should be provided to all affected patients to help them cope with the emotional aspects of their condition, as well as help manage treatment expectations. […] With chronic medical conditions such as renal failure, and diabetes mellitus among the key precipitants of the disease, wound care experts must ensure these conditions are adequately controlled using medical or surgical treatments. Well-controlled underlying conditions will improve the prognosis for patients with the condition. […] Patients diagnosed with calciphylaxis may also benefit from newer therapeutic approaches that aim to aid wound healing and reduce blood calcium levels. Examples include: Hyperbaric oxygen therapy, Dialysis support with intravenous sodium thiosulphate, Calcimimetics, Bisphosphonates.

• #19 Calciphylaxis Treatment & Management: Medical Care, Surgical Care, Diet

  https://emedicine.medscape.com/article/1095481-treatment

  Patients with abnormalities in calcium and phosphate homeostasis should be referred to a dietitian well versed in the dietary needs and restrictions of patients with end-stage renal disease (ESRD). Special consideration should be given to phosphate restriction. […] The patient’s activity may be greatly hampered by the pain and the ulceration of calciphylaxis lesions. Patients are generally hospitalized in intensive care units (ICUs) during the acute illness. […] Consultation with a surgeon regarding wound debridement and possible parathyroidectomy is appropriate. Consultation with a dietitian regarding dietary alterations is appropriate. Consultation with a pain-management specialist may be warranted.

• #20 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  Routine wound care practices like wound cleansing, debridement, and dressing are vital to the management of patients with ulcerations from calciphylaxis. In some cases, the debridement will be done surgically. […] Nutritionists, and other wound care experts should counsel patients to restructure their diets. Foods with high calcium (milk, yogurt, cheese) and phosphorus (beer, cola, asparagus, nuts, spinach) should be limited and replaced with equally nutritious alternatives where possible. […] Developing calciphylaxis can be a mentally traumatizing experience for patients. Psychological support therapy should be provided to all affected patients to help them cope with the emotional aspects of their condition, as well as help manage treatment expectations. […] With chronic medical conditions such as renal failure, and diabetes mellitus among the key precipitants of the disease, wound care experts must ensure these conditions are adequately controlled using medical or surgical treatments. Well-controlled underlying conditions will improve the prognosis for patients with the condition. […] Patients diagnosed with calciphylaxis may also benefit from newer therapeutic approaches that aim to aid wound healing and reduce blood calcium levels. Examples include: Hyperbaric oxygen therapy, Dialysis support with intravenous sodium thiosulphate, Calcimimetics, Bisphosphonates.

• #21 Atypical Wounds – Calciphylaxis | AccessMedicine Network

  http://www.accessmedicinenetwork.com/users/253399-rose-hamm/posts/atypical-wounds-calciphylaxis

  Calciphylaxis is a disorder that causes calcification and thrombosis of the cutaneous blood vessels, resulting in painful ischemic skin and subcutaneous wounds that require a multidisciplinary approach for medical, wound, and rehab management. […] The initial cutaneous manifestations of calciphylaxis are sudden-appearing red or violaceous mottled plaques in a livedo reticularis pattern accompanied with severe pain that is either ischemic or neuropathic. […] Multiple approaches to medical management of calciphylaxis are recommended to prevent infection, manage pain, and optimize outcomes by chelating the arterial calcium. Treatment strategies include the following: Systemic antibiotics, Opioid pain medication, Phosphate binders such as sevelamer, Sodium thiosulfate as a chelating agent for calcium deposits in the tissue, Bisphosphonate therapy to help remove arterial calcification, Low calcium hemodialysis for patients with ESRD, Cinacalcet to lower parathyroid levels and improve calcium-phosphorus homeostasis, Hyperbaric oxygen therapy to increase local tissue oxygen perfusion, Low calcium diet that will also optimize nutrition and provide adequate calorie and protein intake for wound healing.

• #22 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  Routine wound care practices like wound cleansing, debridement, and dressing are vital to the management of patients with ulcerations from calciphylaxis. In some cases, the debridement will be done surgically. […] Nutritionists, and other wound care experts should counsel patients to restructure their diets. Foods with high calcium (milk, yogurt, cheese) and phosphorus (beer, cola, asparagus, nuts, spinach) should be limited and replaced with equally nutritious alternatives where possible. […] Developing calciphylaxis can be a mentally traumatizing experience for patients. Psychological support therapy should be provided to all affected patients to help them cope with the emotional aspects of their condition, as well as help manage treatment expectations. […] With chronic medical conditions such as renal failure, and diabetes mellitus among the key precipitants of the disease, wound care experts must ensure these conditions are adequately controlled using medical or surgical treatments. Well-controlled underlying conditions will improve the prognosis for patients with the condition. […] Patients diagnosed with calciphylaxis may also benefit from newer therapeutic approaches that aim to aid wound healing and reduce blood calcium levels. Examples include: Hyperbaric oxygen therapy, Dialysis support with intravenous sodium thiosulphate, Calcimimetics, Bisphosphonates.

• #23 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  Routine wound care practices like wound cleansing, debridement, and dressing are vital to the management of patients with ulcerations from calciphylaxis. In some cases, the debridement will be done surgically. […] Nutritionists, and other wound care experts should counsel patients to restructure their diets. Foods with high calcium (milk, yogurt, cheese) and phosphorus (beer, cola, asparagus, nuts, spinach) should be limited and replaced with equally nutritious alternatives where possible. […] Developing calciphylaxis can be a mentally traumatizing experience for patients. Psychological support therapy should be provided to all affected patients to help them cope with the emotional aspects of their condition, as well as help manage treatment expectations. […] With chronic medical conditions such as renal failure, and diabetes mellitus among the key precipitants of the disease, wound care experts must ensure these conditions are adequately controlled using medical or surgical treatments. Well-controlled underlying conditions will improve the prognosis for patients with the condition. […] Patients diagnosed with calciphylaxis may also benefit from newer therapeutic approaches that aim to aid wound healing and reduce blood calcium levels. Examples include: Hyperbaric oxygen therapy, Dialysis support with intravenous sodium thiosulphate, Calcimimetics, Bisphosphonates.

• #24 Wound Care for Patients with Calciphylaxis | Wound Care

  https://www.thewoundpros.com/post/wound-care-for-patients-with-calciphylaxis

  Routine wound care practices like wound cleansing, debridement, and dressing are vital to the management of patients with ulcerations from calciphylaxis. In some cases, the debridement will be done surgically. […] Nutritionists, and other wound care experts should counsel patients to restructure their diets. Foods with high calcium (milk, yogurt, cheese) and phosphorus (beer, cola, asparagus, nuts, spinach) should be limited and replaced with equally nutritious alternatives where possible. […] Developing calciphylaxis can be a mentally traumatizing experience for patients. Psychological support therapy should be provided to all affected patients to help them cope with the emotional aspects of their condition, as well as help manage treatment expectations. […] With chronic medical conditions such as renal failure, and diabetes mellitus among the key precipitants of the disease, wound care experts must ensure these conditions are adequately controlled using medical or surgical treatments. Well-controlled underlying conditions will improve the prognosis for patients with the condition. […] Patients diagnosed with calciphylaxis may also benefit from newer therapeutic approaches that aim to aid wound healing and reduce blood calcium levels. Examples include: Hyperbaric oxygen therapy, Dialysis support with intravenous sodium thiosulphate, Calcimimetics, Bisphosphonates.

• #25 FF #325 Uremic Calciphylaxis | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/uremic-calciphylaxis/

  Calciphylaxis is a poorly understood disorder in which calcification of small blood vessels causes painful ischemic skin and visceral lesions most often in patients with end-stage renal disease (ESRD). This Fast Fact will review its clinical presentation and offer recommendations for advance care planning and symptom management. […] In general, most experts recommend a multi-modal approach involving adequate wound care, pain control, and treatment of hyperparathyroidism. This includes a low phosphate diet, use of non-calcium based phosphate binders (i.e., sevelamer), and cessation of vitamin D supplementation. […] Considering the one-year mortality risk, the diagnosis of calciphylaxis should prompt clinicians to engage patients and families in a larger discussion regarding advance directives, prognosis, and goals of care. […] While the Medicare Hospice Benefit (MHB) can provide important care resources and support for patients with calciphylaxis, MHB patients are typically unable to continue dialysis with a hospice admitting diagnosis of ESRD.

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